title: One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fraction.
abstract: Wave intensity (WI) is a hemodynamic index used to evaluate the interaction between the heart and the arterial system, measured with an echo-Doppler system at the level of the common carotid artery. WI has two peaks: W1 during early systole that represents left ventricular (LV) contractility, and W2 in late systole that is related to the inertia force during isovolumetric relaxation. The aim of this study was to determine whether WI parameters improve the prediction of poor outcome in patients with heart failure and reduced ejection fraction (HFrEF). Sixty-two patients (mean age 69.4 ± 11.5 years) in NYHA class II-III were followed up for 43.5 months. They underwent routine clinical work-up, transthoracic echocardiography and WI measurement. A stratified survival analysis was conducted using the Kaplan-Meier method. During follow-up, 23 patients died from cardiovascular causes. Survivors and non-survivors were similar in age, blood pressure, heart rate and echocardiographic parameters, except for LV end-diastolic volume indexed to body surface area, E/A ratio (higher in non-survivors) and deceleration time (lower in non-survivors). W2 (1950 ± 1006 vs 1117 ± 708 mmHg m/s(3), p = 0.001) was significantly lower in non-survivors, whereas W1 (6951 ± 4119 vs 5748 ± 3891 mmHg m/s(3), p = NS) was similar. At the end of follow-up, cardiovascular mortality was higher in patients with W1 ≤ 3900 mmHg m/s(3) (p = 0.02) and W2 ≤ 1000 mmHg m/s(3) (p = 0.0002). Only E/A (cut-off 1.5) was predictive of mortality (p = 0.05). In patients with HFrEF, WI parameters derived from the carotid artery better identified patients with poor prognosis and were significant predictors of cardiovascular mortality.
authors.affiliation: Cardiology and Emergency Department, Sant'Antonio Hospital, Via Trento-Trieste, 33038, San Daniele del Friuli, Udine, Italy. olgavriz@yahoo.com.
authors.forename: Olga
authors.initials: O
authors.lastname: Vriz
authors.affiliation: Cardiology, ARC, S. Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pellegrinet
authors.affiliation: Institute of Cardiology, University of Messina, Messina, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.affiliation: Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
authors.forename: Vitantonio
authors.initials: V
authors.lastname: di Bello
authors.affiliation: Cardiology and Emergency Department, Sant'Antonio Hospital, Via Trento-Trieste, 33038, San Daniele del Friuli, Udine, Italy.
authors.forename: Manola
authors.initials: M
authors.lastname: Bettio
authors.affiliation: Institute of Cardiology, University of Messina, Messina, Italy.
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
authors.affiliation: Department of Translational Medical Sciences, Federico II University, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Cittadini
authors.affiliation: Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: Cardiology, ARC, S. Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Antonini-Canterin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: Cardiovascular mortality; Ejection fraction; Heart failure; Wave intensity