title: Prognostic importance of tissue velocity imaging during exercise echocardiography in patients with systolic heart failure.
abstract: Resting echocardiography measurements are poor predictors of exercise capacity and symptoms in patients with heart failure (HF). Stress echocardiography may provide additional information and can be expressed using left ventricular ejection fraction (LVEF), or diastolic parameters (E/E'), but LVEF has some major limitations. Systolic annular velocity (S') provides a measure of longitudinal systolic function, which is relatively easy to obtain and shows a good relationship with exercise capacity. The objective of this study was to investigate the relationship among S', E/E' and LVEF obtained during stress echocardiography and both mortality and hospitalisation. A secondary objective was to compare S' measured using a simplified two-wall model. A total of 80 patients with stable HF underwent exercise stress echocardiography and simultaneous cardiopulmonary exercise testing. Volumetric and tissue velocity imaging (TVI) measurements were obtained, as was peak oxygen uptake (VO2 peak). Of the total number of patients, 11 died and 22 required cardiac hospitalisation. S' at peak exertion was a powerful predictor for death and hospitalisation. Cut-off points of 5.3 cm/s for death and 5.7 cm/s for hospitalisation provided optimum sensitivity and specificity. This study suggests that, in patients with systolic HF, S' at peak exertion calculated from the averaged spectral TVI systolic velocity of six myocardial segments, or using a simplified measure of two myocardial segments, is a powerful predictor of future events and stronger than LVEF, diastolic velocities at rest or exercise and VO2 peak. Results indicate that measuring S' during exercise echocardiography might play an important role in understanding the likelihood of adverse clinical outcomes in patients with HF.
authors.affiliation: Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK.
authors.forename: Jet
authors.initials: J
authors.lastname: van Zalen
authors.affiliation: Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK.
authors.forename: Nikhil R
authors.initials: NR
authors.lastname: Patel
authors.affiliation: Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK.
authors.forename: Steven
authors.initials: S
authors.lastname: J Podd
authors.affiliation: Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Raju
authors.affiliation: Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK.
authors.forename: Rob
authors.initials: R
authors.lastname: McIntosh
authors.affiliation: School of Sport and Service Management, University of Brighton , Hillbrow, Denton Road, Eastbourne, BN20 7SR , UK.
authors.forename: Gary
authors.initials: G
authors.lastname: Brickley
authors.affiliation: School of Sport and Service Management, University of Brighton , Hillbrow, Denton Road, Eastbourne, BN20 7SR , UK.
authors.forename: Louisa
authors.initials: L
authors.lastname: Beale
authors.affiliation: Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK.
authors.forename: Lydia P
authors.initials: LP
authors.lastname: Sturridge
authors.affiliation: Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK.
authors.forename: Guy W L
authors.initials: GW
authors.lastname: Lloyd
keywords: left ventricular ejection fraction; stress echocardiography; tissue Doppler imaging