A new tissue Doppler index to predict cardiac death in patients with heart failure

It has been shown that a new tissue Doppler index, E/(E'×S'), including the ratio between early diastolic transmitral and mitral annular velocity (E/E'), and the systolic mitral annular velocity (S'), has a good accuracy to predict left ventricular filling pressure.

We investigated the value of E/(E'×S') to predict cardiac death in patients with heart failure.

Echocardiography was performed in 339 consecutive hospitalized patients with heart failure, in sinus rhythm, after appropriate medical treatment, at discharge and after one month. Worsening of E/(E'×S') was defined as any increase of baseline value. The end point was cardiac death.

During the follow-up period (35.2 ± 8.8 months), cardiac death occurred in 51 patients (15%). The optimal cut-off value for the initial E/(E'×S') to predict cardiac death was 2.83 (76% sensitivity, 85% specificity). At discharge, 252 patients (74.3%) presented E/(E'×S') ≤ 2.83 (group I) and 87 (25.7%) presented E/(E'×S') > 2.83 (group II), respectively. Cardiac death was significantly higher in group II than in group I (38 deaths, 43.7% vs 13 deaths, 5.15%, p < 0.001). By multivariate Cox regression analysis, including variables that affected outcome in univariate analysis, E/(E'×S') at discharge was the best independent predictor of cardiac death (hazard ratio = 3.09, 95% confidence interval = 1.81-5.31, p = 0.001). Patients with E/(E'×S') > 2.83 at discharge and its worsening after one month presented the worst prognosis (all p < 0.05).

In patients with heart failure, the E/(E'×S') ratio is a powerful predictor of cardiac death, particularly if it is associated with its worsening.