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Published on: December 11, 2017
Predictors of cardiac events after cardiac resynchronization therapy with tissue Doppler-derived parameters
Osama I I Soliman1, Dominic A M J Theuns, Folkert J Ten Cate
1Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
Tissue Doppler Imaging (TDI) parameters, specifically the E/E' ratio and Tei index, predict cardiac events in heart failure patients undergoing cardiac resynchronization therapy (CRT). These measures indicate a higher risk of adverse outcomes post-CRT.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Heart failure (HF) remains a significant clinical challenge.
- Cardiac resynchronization therapy (CRT) is a key treatment for select HF patients.
- Prognostic markers to predict CRT response are crucial for optimizing patient outcomes.
Purpose of the Study:
- To assess the prognostic capability of Tissue Doppler Imaging (TDI)-derived parameters, namely the E/E' ratio and Tei index.
- To determine the predictive value of these TDI parameters for cardiac events in patients receiving CRT.
Main Methods:
- Seventy-four heart failure patients undergoing CRT were studied.
- Echocardiography with TDI measurements was performed at baseline and 3 months post-CRT.
- Cox regression analysis (univariable and multivariable) was used to identify predictors of cardiac events during a median follow-up of 720 days.
Main Results:
- Diabetes, baseline E/A ratio, and baseline E/E' ratio were univariable predictors of cardiac events.
- At 3-month follow-up, E/A ratio, E/E' ratio, left ventricular ejection fraction, deceleration time, and Tei index predicted events.
- Multivariable analysis identified diabetes, 3-month E/E' ratio, and change in Tei index as independent predictors. Patients with high E/E' ratios (baseline and 3-month) had an 88% event rate.
Conclusions:
- The Tei index and E/E' ratio derived from TDI are significant independent predictors of poor CRT response.
- Elevated Tei index and E/E' ratio identify patients at higher risk for cardiac events following CRT.
- These TDI parameters offer valuable prognostic information for HF patients undergoing CRT.
Background:
To evaluate the prognostic value of tissue Doppler imaging (TDI)-derived parameters (E/E' ratio and Tei index) in heart failure (HF) patients who underwent cardiac resynchronization therapy (CRT).
Methods And Results:
The study comprised 74 consecutive HF patients (mean age 60 +/- 11 years) who underwent CRT. Echocardiography including TDI measurements was performed in all patients at baseline and 3 months after CRT. During a median follow-up period of 720 days (range 210 to 1020 days), 21 patients (28%) had events (8 deaths, and hospitalization for HF in the remaining 13). From the baseline clinical and echocardiography data, univariable Cox-regressions analysis revealed that only diabetes (hazard ratio [HR] 3.703, P < .01), E/A ratio (HR 3.492, P < .001), and E/E' ratio (HR 1.130, P < .001) were predictors for cardiac events. From the 3-month follow-up data, the E/A ratio (HR 2.988, P < .005), E/E' ratio (HR 1.170, P < .001), left ventricular ejection fraction (HR 0.835, P < .01), deceleration time (HR 0.977, P < .05), and the Tei index (HR 15.784, P < .001) were predictors for cardiac events. After multivariable analysis, only diabetes (HR 5.544, P < .05), the 3-month E/E' ratio (HR 1.229, P < .001), and change in Tei index (HR 32.174, P < .001) were independent predictors for cardiac events. Patients with a high baseline and 3-month follow-up E/E' ratio had an 88% cardiac event rate.
Conclusions:
The Tei index and E/E' ratio are independent predictors of poor response and cardiac events after CRT.
