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Prognostic value of tissue Doppler imaging in patients with chronic congestive heart failure
Tayfun Acil1, Thomas Wichter, Jörg Stypmann
1Department of Cardiology and Angiology, University Hospital of Münster, Germany.
Insights
Tissue Doppler imaging (TDI) parameters, specifically the mitral E/E'-ratio, are superior predictors of cardiac events in chronic heart failure (CHF) patients compared to traditional measures. This ratio aids in risk stratification for improved patient outcomes.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Prognostic value of Tissue Doppler Imaging (TDI) in chronic congestive heart failure (CHF) remains uncompared to conventional left ventricular (LV) performance measures.
- Assessing TDI-derived parameters for prognostic value in CHF patients is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the prognostic significance of TDI-derived parameters in patients diagnosed with chronic CHF.
- To compare the predictive capability of TDI parameters against standard systolic, diastolic, and overall LV function assessments.
Main Methods:
- 132 chronic CHF patients (ischemic or dilated cardiomyopathy) underwent conventional echocardiography and TDI.
- Key measurements included mitral annular velocities (S', E', A') and the Tei-index.
- Cardiac events (death, transplantation, hospitalization) were tracked as the primary endpoint.
Main Results:
- The mitral E/E -ratio and Tei-index were significantly elevated in patients experiencing cardiac events.
- Multivariate analysis identified the mitral E/E -ratio and Tei-index as independent predictors of combined cardiac events.
- The mitral E/E -ratio demonstrated superior predictive power for hospitalization due to CHF.
Conclusions:
- The mitral E/E -ratio is a stronger predictor of future cardiac events in chronic CHF patients than conventional LV performance parameters.
- Incorporating the mitral E/E -ratio into routine follow-up may enhance risk stratification and management of CHF patients.
Background:
The prognostic value of tissue Doppler imaging (TDI) in patients with chronic congestive heart failure (CHF) has not been compared against conventional measures of systolic, diastolic and overall left ventricular LV performance. The aim of this study was to assess the prognostic value of TDI-derived parameters in patients with CHF.
Methods:
One hundred thirty-two subjects with chronic CHF [due to ischemic (n=82) or dilated (n=50) cardiomyopathy, 101 males, mean age 57+/-11 years] underwent conventional two-dimensional/Doppler echocardiography and assessment of the Tei-index (isovolumic contraction time and isovolumic relaxation time divided by ejection time). Systolic, early and late diastolic mitral annular velocities (S', E' and A') were derived from pulsed TDI. A cardiac event (cardiac death, urgent cardiac transplantation or hospitalization due to decompensated CHF) was defined as the combined study endpoint.
Results:
The patients were followed for a mean of 224+/-123 days. Thirty-one patients suffered an event (cardiac death, n=5; urgent cardiac transplantation, n=2; hospitalization due to CHF, n=24). In patients with event, ejection fraction was lower (25+/-10 vs. 32+/-9%), mitral deceleration time was shorter (138+/-58 vs. 193+/-72 ms), and the peak mitral E/E'-ratio (16.1+/-6.6 vs. 10.6+/-5.0) was significantly elevated as compared to patients free of events (p<0.001 for all comparisons). In those patients, the Tei-index was elevated (1.09+/-0.39 vs. 0.86+/-0.26, p<0.01), and a restrictive mitral filling pattern was more frequent (51.6 vs. 17.5%, p<0.001). Stepwise multivariate analysis identified the mitral E/E'-ratio (p<0.001) and the Tei-index (p=0.019) as the only independent predictors of a combined event. E/E'-ratio was the best predictor of hospitalization due to CHF also. In patients with mitral E/E'-ratio>12.5 or Tei-index>0.90, outcome was poor.
Conclusions:
In subjects with chronic CHF, the mitral E/E'-ratio is a stronger predictor of future cardiac events than conventional parameters of systolic, diastolic or overall LV performance. The E/E'-ratio may be a useful addition in the routine follow-up of such patients.
