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Influence of left ventricular diastolic filling on symptoms and survival in patients with decreased left ventricular
I P Clements1, M L Brown, A R Zinsmeister
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Left ventricular (LV) filling variables, including time to peak filling rate and peak filling rate, are valuable predictors of survival in patients with reduced LV systolic function. These diastolic measures offer prognostic insights beyond clinical symptoms.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- Reduced left ventricular (LV) systolic function is a significant concern in cardiovascular disease.
- Assessing diastolic function complements systolic assessment for comprehensive patient evaluation.
- Predicting survival in this patient group is crucial for guiding clinical management.
Purpose of the Study:
- To investigate the relationship between LV diastolic filling variables and clinical symptoms.
- To determine the association of LV filling parameters with survival in patients with decreased LV systolic function.
- To evaluate the prognostic value of radionuclide ventriculography-derived diastolic indices.
Main Methods:
- Gated blood pool radionuclide ventriculography was used to measure LV filling variables in 93 patients.
- Patients had pre-existing decreased LV systolic function.
- Stepwise Cox regression analysis and Kaplan-Meier survival analysis were employed.
Main Results:
- Diastolic filling variables did not correlate significantly with clinical symptoms.
- Time to peak filling rate, peak filling rate, and ejection fraction were independent predictors of cardiac survival.
- Faster time to peak filling rate or higher peak filling rate correlated with decreased survival, indicating a poorer prognosis.
Conclusions:
- LV filling variables, specifically time to peak filling rate and peak filling rate, are valuable prognostic indicators.
- Radionuclide ventriculography provides important diastolic information for predicting survival in patients with impaired LV systolic function.
- These findings support the use of diastolic filling parameters in risk stratification.
Abstract:
The relation between left ventricular (LV) filling variables measured by gated blood pool radionuclide ventriculography and clinical symptoms and survival was examined in 93 patients who had decreased LV systolic function. The diastolic data were not significantly associated with clinical symptoms. Time to peak filling rate, peak filling rate and ejection fraction were associated independently with survival free of cardiac death (chi-square = 7.74, 5.91 and 3.92, respectively, by stepwise Cox regression analysis). A short time to peak filling rate or increased peak filling rate was associated with decreased survival, whereas the opposite indicated a good prognosis. One-year Kaplan-Meier survival was 73 and 98% when time to peak filling rate was below or above the median value of 167 ms, respectively, 82 and 90% when peak filling rate was above or below the median value of 1.67 end-diastolic volumes per second, respectively, and 76 and 95% when LV ejection fraction was below or above the median value of 0.35, respectively. Thus, filling variables (time to peak filling rate and peak filling rate) measured by radionuclide ventriculography may be valuable in predicting survival in patients with decreased LV systolic function.