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Cardiac dysfunction assessed by echocardiographic tissue Doppler imaging is an independent predictor of mortality in
Rasmus Mogelvang1, Peter Sogaard, Sune A Pedersen
1Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg Hospital, Copenhagen, Denmark. Rasmus.Mogelvang@get2net.dk
Insights
Tissue Doppler imaging (TDI) can predict death in the general population. Left ventricular dysfunction detected by TDI, especially when considering both systolic and diastolic function, is a significant independent predictor of mortality.
Area of Science:
- Cardiology
- Echocardiography
- Preventive Medicine
Background:
- Tissue Doppler imaging (TDI) is used to identify left ventricular dysfunction in heart failure patients with preserved ejection fraction.
- The prognostic value of TDI-detected left ventricular dysfunction in the general population remains unclear.
Purpose of the Study:
- To investigate the prognostic significance of left ventricular dysfunction, as assessed by TDI, in a general population.
- To determine if TDI can predict mortality independently of conventional echocardiographic parameters and clinical risk factors.
Main Methods:
- Cardiac function was assessed using conventional echocardiography and TDI in 1036 participants from the Copenhagen City Heart Study.
- Peak systolic (s'), early diastolic (e'), and late diastolic (a') velocities were averaged from six mitral annular sites.
- A combined index (eas index) of diastolic and systolic performance (e'/(a' x s')) was calculated.
Main Results:
- During a median follow-up of 5.3 years, 90 participants died.
- Low s' and a' velocities by TDI were significant predictors of death, even after adjusting for clinical variables and conventional echocardiography.
- The combined eas index showed a significantly increased hazard ratio for death in the highest tertile compared to the lowest (HR 2.5, P<0.005).
Conclusions:
- Left ventricular dysfunction detected by TDI is a powerful and independent predictor of death in the general population.
- TDI is particularly effective in predicting mortality when both systolic and diastolic performance are considered together.
- These findings highlight the value of TDI in assessing cardiac function and risk stratification in individuals without overt cardiac disease.
Background:
Tissue Doppler imaging (TDI) detects left ventricular dysfunction in patients with heart failure and normal ejection fraction, but the prognostic significance of left ventricular dysfunction by TDI in the general population is unknown.
Methods And Results:
Within the Copenhagen City Heart Study, a large community-based population study, cardiac function was evaluated in 1036 participants by both conventional echocardiography and TDI. Averages of peak systolic (s'), early diastolic (e'), and late diastolic (a') velocities from 6 mitral annular sites were used. TDI was furthermore quantified by a combined index (eas index) of diastolic and systolic performance: e'/(a' x s'). During follow-up (median, 5.3 years), 90 participants died. Left ventricular dysfunction by TDI, in terms of low s' (hazard ratio, 1.23 per 1-cm/s decrease; P<0.05) and a' (hazard ratio, 1.20 per 1-cm/s decrease; P=0.001), were significant predictors of death in Cox proportional-hazards models adjusted for clinical variables (age, sex, body mass index, heart rate, hypertension, diabetes mellitus, and ischemic heart disease) and conventional echocardiography. The adjusted hazard ratio for death in the third tertile compared with the first tertile of the combined index of systolic and diastolic performance by TDI was 2.5 (P<0.005).
Conclusions:
In the general population, in which most are free of left ventricular systolic dysfunction and restrictive diastolic filling using conventional echocardiographic parameters, left ventricular dysfunction by TDI is a powerful and independent predictor of death, especially when systolic performance and diastolic performance are considered together, recognizing their interdependency and their complex relation to deteriorating cardiac function.
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