title: Early improvement in serial echocardiographic studies in heart failure patients predicts long term survival-a pilot study.
abstract: BACKGROUND
  Several echocardiographic measures have prognostic value in heart failure (HF). However, no definitive data exist on how changes in these parameters with treatment affect survival in this patient population. We hypothesized that early improvement on echocardiography could predict long-term survival.
  
  
  RESULTS
  We conducted a retrospective review of 404 patients seen in the HF clinic from 2002 to 2008 (6.5 years). Patients had one echocardiogram ≤1 year before and another ≥1 month (10 ± 7 months) after treatment onset. We studied changes in standard echocardiographic parameters, including left (LV) and right (RV) ventricular size and/or function (systolic and/or diastolic), valvular (mitral and tricuspid) function, and pulmonary artery pressure. Survival curves and hazard ratios were generated for patients showing improvement on the 2nd echocardiogram versus those who did not. Multivariable analyses were performed adjusting for age, sex, ischemic etiology, and significant baseline echocardiographic parameters. Average follow-up was 2.9 ± 1.5 years. Improvement in LV end-systolic dimension, RV function, and mitral regurgitation were independent predictors of 5-year survival (P < .05) and, importantly, more predictive than baseline values of these parameters alone (higher hazard ratios).
  
  
  CONCLUSIONS
  Early echocardiographic improvement is strongly associated with 5-year survival in patients with HF. Serial echocardiography may aid in stratifying patient care.
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois. Electronic address: kaddetia@medcine.bsd.uchicago.edu.
authors.forename: Karima
authors.initials: K
authors.lastname: Addetia
authors.affiliation: Division of Cardiology, Department of Medicine, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Michel
authors.affiliation: Division of Clinical Epidemiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Holcroft
authors.affiliation: Division of Cardiology, Department of Medicine, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Sheppard
authors.affiliation: Division of Cardiology, Department of Medicine, Jewish General Hospital/McGill University, Montreal, Quebec, Canada. Electronic address: Lawrence.rudski@mcgill.ca.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Rudski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D008991:Monitoring, Physiologic / Q000379:methods; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Heart failure; echocardiography; prognosis; survival