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Echocardiographic patterns and prognosis in heart failure
R A Rodrigues1, P Dias, M Pereira
1Serviço de Cardiologia e Serviço de Medicina 3 do Hospital de S. João-Porto. ruiarodrigues@hotmail.com
Insights
Echocardiography reveals that restrictive ventricular filling patterns and impaired left ventricular systolic function are key indicators for heart failure (HF) prognosis. These findings help predict hospital admissions and mortality in HF patients.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Heart failure (HF) prognosis is influenced by various factors, with left ventricular function being paramount.
- Pulsed Doppler echocardiography is increasingly studied for its prognostic value in assessing ventricular filling patterns.
Purpose of the Study:
- To evaluate the prognostic significance of echocardiographic variables, both diastolic and systolic, in patients with heart failure.
- To correlate these echocardiographic findings with cardiovascular hospital admissions or death.
Main Methods:
- 157 consecutive heart failure patients were evaluated; 110 in sinus rhythm were included (mean age 68.2 years, 52.7% ischemic HF).
- Patients were categorized by left ventricular (LV) systolic dysfunction (ejection fraction < 40%) and restrictive diastolic filling patterns.
- Four groups were formed based on combinations of systolic function and diastolic patterns; outcomes (death/admission) were tracked over a mean of 625 days.
Main Results:
- Impaired LV systolic function was present in 73.6% and restrictive filling patterns in 45.5% of patients.
- 41.8% of patients experienced death or hospital admission during follow-up.
- Patients with systolic HF or restrictive filling patterns showed significantly lower admission-free survival rates.
Conclusions:
- Diastolic function variables, specifically restrictive ventricular filling patterns, possess independent prognostic value in heart failure.
- Echocardiographic assessment of ventricular filling patterns is crucial for predicting outcomes in HF patients.
- Combining systolic and diastolic evaluations provides a comprehensive prognostic outlook.
Background:
There are many variables with prognostic value in patients with heart failure (HF). Those related to left ventricular function are among the most important. Recently, the evaluation of the patterns of ventricular filling by pulsed Doppler echocardiography has been studied as a variable with prognostic value.
Objectives:
To evaluate the prognostic value of echocardiography variables (diastolic and systolic) in patients with HF. These variables were analysed in respect to hospital admission for cardiovascular reasons or death.
Material And Methods:
We evaluated 157 consecutive patients with HF and included 110 patients who were in sinus rhythm. The mean age was 68.2 +/- 0.9 years. HF was ischemic in 52.7%. Patients underwent echocardiography examination within the week of reference. The patients were grouped according to left ventricular (LV) systolic dysfunction (LV ejection fraction < 40%). We also classified patients in two groups according to the presence of a restrictive pattern in diastolic transmitral flow profile. Finally, we classified all patients in four groups according to their systolic function and diastolic pattern: Group I--systolic dysfunction and restrictive ventricular filling pattern. Group II--systolic dysfunction without restrictive ventricular filling pattern. Group III--without systolic dysfunction with restrictive ventricular filling pattern. Group IV--without systolic dysfunction without restrictive ventricular filling pattern. The events were death or hospital admission. The mean follow up time was 625 +/- 55 days. We did a statistical analysis and for all tests a p value < 0.05 was considered statistically significant.
Results:
We found impaired LV systolic function (systolic HF) in 73.6% and restrictive ventricular filling pattern in 45.5%. During the follow-up 41.8% died or were admitted to hospital. Patients with systolic HF had lower admission free survival rate. Patients with restrictive ventricular filling pattern had lower admission free survival rate than those without. Group I had lower admission free survival rate than Group II and Group IV. Group IV had a higher admission free survival than all other Groups.
Conclusions:
These results support and expand previous observations that diastolic function variables, such as the pattern of ventricular filling (namely the restrictive) have independent prognostic value in patients with HF.