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Tissue Doppler imaging as a long-term prognostic index in left ventricular systolic dysfunction
Roberto Magalhães Saraiva1, Rita de Cássia Castelli da Rocha, Adriana Ferraz Martins
1Total Care, Rio de Janeiro, RJ - Brasil. rsaraiva@cardiol.br
Insights
The E/E
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Tissue Doppler parameters offer insights into left ventricular (LV) filling pressures.
- These parameters serve as valuable prognostic indicators for heart failure patients.
Purpose of the Study:
- To investigate the predictive capability of tissue Doppler parameters for long-term adverse events in outpatients with LV systolic dysfunction.
- To establish the prognostic value of the E/E' ratio in predicting heart failure outcomes.
Main Methods:
- A retrospective analysis of 73 outpatients with LV systolic dysfunction who underwent Doppler echocardiography.
- Primary endpoint: all-cause mortality or hospitalization for heart failure exacerbation.
- Logistic stepwise multivariate analysis identified significant predictors.
Main Results:
- The E/E' ratio and LV ejection fraction (EF) were significant predictors of adverse outcomes.
- Optimal cutoffs for prediction were an E/E' ratio of 12.7 and an EF of 30%.
- Patients with E/E' ratio > 12.7 or EF < 30% had significantly poorer outcomes.
Conclusions:
- The E/E' ratio is a crucial, independent predictor of long-term mortality or hospitalization in heart failure patients.
- Routine measurement of the E/E' ratio is recommended for managing outpatients with LV systolic dysfunction.
- The E/E' ratio provides prognostic information even in patients with preserved ejection fraction.
Background:
Tissue Doppler parameters correlate with left ventricular (LV) filling pressure and can be useful as prognostic indexes for patients with heart failure.
Objective:
Determine whether tissue Doppler parameters can predict events during long term follow-up of outpatients with LV systolic dysfunction.
Methods:
Retrospective study with 73 patients (aged 60.9+/-12.1 years) who underwent Doppler echocardiogram between March 2001 and May 2004. The primary endpoint studied was death or hospitalization due to heart failure worsening.
Results:
The mean follow-up period was 1,367+/-665 days. After logistic stepwise multivariate analysis, including echocardiographic parameters, the ratio of maximal early diastolic filling wave velocity to maximal early diastolic myocardial velocity (E/E; ratio; p=0.0007), and LV ejection fraction (EF; p=0.01) remained significant predictors of the primary outcome. The optimal cutoffs for primary endpoint prediction for E/E' ratio (AUC 0.77; p=0.0001) and EF (AUC 0.68, p=0.006) were respectively 12.7 and 30%. Accordingly, patients with E/E' ratio > 12.7 (hazard ratio=3.8, p =0.001) or EF <30% (hazard ratio=2.3, p=0.03) had a poorer outcome by survival curve analysis. It is noteworthy that 47% of the patients with EF above the optimal cutoff point, but with high E/E' ratio, presented events during follow-up.
Conclusion:
E/E' ratio is an important independent long-term prognostic index of death or hospitalization due to worsening heart failure in outpatients with LV systolic dysfunction. Therefore, we recommend the measurement of this variable in the routine evaluation of such patients.
