title: Ratio of transmitral early filling velocity to early diastolic strain rate predicts outcomes in patients with systolic heart failure.
abstract: OBJECTIVE
  The ratio of transmitral early filling velocity (E) to early diastolic tissue velocity (E') is a key diastolic function parameter. The early diastolic strain rate (E'sr) has been proposed as a substitute for E' in the E/E' ratio for better estimation of left ventricular (LV) filling pressure. This study aims to assess the predictive value of combined E/E'sr ratio and global longitudinal strain (GLS) for prognosis in systolic heart failure (SHF).
  
  
  RESULTS
  We retrospectively analysed 330 SHF patients with an LV ejection fraction (LVEF) ≤ 40%. Study end points were defined as all-cause mortality or heart transplantation. The incremental value of GLS and the E/E'sr ratio over LVEF and E/E' for outcome prediction was assessed using nested Cox models. Ninety-nine (30%) patients reached the end point over a median follow-up of 46 months. Baseline variables associated with outcomes were age, glomerular filtration rate, pulmonary artery systolic pressure, and LV end-systolic volume index. After multivariate adjustment, GLS (hazard ratio: 1.48, P = 0.025) and the E/E'sr ratio (hazard ratio: 1.41, P = 0.002) were both independent predictors. LVEF or E/E' was not an independent predictor when GLS and E/E'sr were included in the model. Patients with impaired GLS (absolute value <7.5%) and elevated E/E'sr ratios (E/E'sr ≥ 195 cm) showed poor outcomes.
  
  
  CONCLUSIONS
  The E/E'sr ratio is stronger than E/E' ratio in predicting prognosis of patients with systolic HF. Combined assessments of GLS and E/E'sr by speckle-tracking longitudinal strain facilitate risk stratification of these patients.
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yi-Hsin
authors.initials: YH
authors.lastname: Chan
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsin-Fu
authors.initials: HF
authors.lastname: Lee
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Lung-Sheng
authors.initials: LS
authors.lastname: Wu
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan wang3015@adm.cgmh.org.tw.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chun-Li
authors.initials: CL
authors.lastname: Wang
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chia-Tung
authors.initials: CT
authors.lastname: Wu
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yung-Hsin
authors.initials: YH
authors.lastname: Yeh
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Y Wan-Jing
authors.initials: YW
authors.lastname: Ho
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Lung-An
authors.initials: LA
authors.lastname: Hsu
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
authors.affiliation: The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, 5, Fushin Street, Kweishan Hsiang, Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chi-Tai
authors.initials: CT
authors.lastname: Kuo
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001783:Blood Flow Velocity; D002423:Cause of Death; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D017725:Ventricular Pressure; D014850:Waiting Lists
keywords: diastolic function; heart failure; prognosis; speckle-tracking strain