title: Added value of pulmonary venous flow Doppler assessment in patients with preserved ejection fraction and its contribution to the diastolic grading paradigm.
abstract: OBJECTIVE
  To evaluate the prognostic role of pulmonary venous flow parameters and their role in patients with preserved ejection fraction (EF).
  
  
  RESULTS
  Pulmonary venous flow parameters were measured in 365 patients in sinus rhythm, without significant mitral disease, and EF >50% (age 64.9 ± 19; 52% female) by a single sonographer. Survival, time to re-admission for heart failure, and to a combined cardiac end point (cardiac death, heart failure, and atrial fibrillation) were retrospectively analysed and correlated to echo parameters. Systolic (S) and diastolic (D) pulmonary vein flow were obtainable in 73% of patients and Ar in 65%. The lower peak S/D ratio and higher ΔAr-A time were associated with higher rate of heart failure readmission (P = 0.03 for both). The S/D integral ratio was the best pulmonary vein flow predictor of heart failure readmissions (P = 0.0009), better than the peak S/D ratio, or ΔA-Ar time (P < 0.01 for both), and independently predicted worse outcome even when adjusted for diastolic grading (using recent guidelines), left ventricle mass index, E/e', and left atrial volume index (P < 0.05 for all). The addition S/D ratio to diastolic grading recognized patients with pseudo-normal filling pattern and S/D ratio >1 with similar clinical outcomes to grade I (P > 0.5), but worse clinical outcomes than in the pseudo-normal patients with lower S/D ratio (P < 0.01).
  
  
  CONCLUSIONS
  PVFP are obtainable in most patients, add prognostic information on top of routine diastolic parameters, and define an early stage of diastolic dysfunction resembling the pseudo-normal pattern in which S/D ratio is >1, and outcome is excellent.
authors.affiliation: The Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel.
authors.forename: Eric
authors.initials: E
authors.lastname: Buffle
authors.affiliation: The Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel.
authors.forename: Judith
authors.initials: J
authors.lastname: Kramarz
authors.affiliation: The Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel.
authors.forename: Esther
authors.initials: E
authors.lastname: Elazar
authors.affiliation: The Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Aviram
authors.affiliation: The Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel.
authors.forename: Meirav
authors.initials: M
authors.lastname: Ingbir
authors.affiliation: Division of Cardiovascular Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Nahum
authors.initials: N
authors.lastname: Nesher
authors.affiliation: The Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel.
authors.forename: Simon
authors.initials: S
authors.lastname: Biner
authors.affiliation: The Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: The Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel topilskyyan@gmail.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000401:mortality; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate
keywords: difference from mitral A-wave duration; ejection fraction; left atrium; left ventricle; pulmonary venous flow parameters; systolic to diastolic ratio