Prognostic Value of Pulse-Wave Tissue Doppler Parameters in Patients With Systolic Heart Failure

• Published in: The American journal of cardiology Vol. 102; no. 6; pp. 722 - 725
• Main Authors: Olson, Jens M., MD, Samad, Bassem A., MD, PhD, Alam, Mahbubul, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.09.2008; Elsevier; Elsevier Limited
• Subjects: Age Factors; Aged; Biological and medical sciences; Blood Flow Velocity - physiology; Cardiology; Cardiology. Vascular system; Cardiovascular; Female; Follow-Up Studies; Heart; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Failure, Systolic - diagnostic imaging; Heart Failure, Systolic - mortality; Heart Failure, Systolic - physiopathology; Heart Ventricles - diagnostic imaging; Humans; Male; Medical prognosis; Medical sciences; Medicin och hälsovetenskap; Mortality; Multivariate Analysis; Prognosis; Prospective Studies; Sensitivity and Specificity; Stroke Volume - physiology; Studies; Ultrasonic imaging; Ultrasonography, Doppler, Pulsed; Sonography; Human; Heart failure; Wave; Prognosis; Heart disease; Pulse; Tissue doppler; Cardiovascular disease; Parameter; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.04.054

The aim was to study the prognostic value of left ventricular (LV) function using pulse-wave tissue Doppler imaging (TDI) in an ordinary population with heart failure (HF). One hundred fifty-six patients hospitalized for HF and LV ejection fraction ≤40% were examined using conventional echocardiography and pulse-wave TDI for the assessment of longitudinal LV function. Mitral annular systolic and early diastolic (e′) velocities were recorded from a mean of 4 annular sites from the apical 2- and 4-chamber views. Noninvasive LV filling pressure was calculated from the ratio between transmitral early inflow velocity (E) and e′. All patients were followed up for 2 years, and data from the National Registry of Deaths were collected. Mean LV ejection fraction was 24.7 ± 7.2%. TDI recordings showed a mean mitral annular systolic velocity of 5.0 ± 1.0 cm/s and e′ velocity of 6.2 ± 1.9 cm/s. E/e′ ratio was 14.1 ± 4.8. Thirty patients (19%) had atrial fibrillation. During follow-up, 27 patients (17%) died of a cardiovascular cause. Multivariate analysis showed that only E/e′ ratio and age were predictors of cardiovascular mortality. A cut-off value for E/e′ ratio >13 had sensitivity of 84% and specificity of 45% to identify patients who died within 2 years of cardiac reasons. In conclusion, in the acute stage of HF, E/e′ ratio is a strong independent predictor of long-term cardiovascular mortality in an ordinary population with HF and systolic dysfunction. Systolic and diastolic velocities had no independent prognostic value.