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Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac
Christina Tan1, David Rubenson1, Ajay Srivastava1
1Fellow, Scripps Clinic Cardiology, 10666 N. Torrey Pines Road, La Jolla, CA, 92037, USA.
Insights
Extremely low left ventricular outflow tract velocity time integral (LVOT VTI) in heart failure patients predicts mortality and need for advanced therapies. This key cardiac systolic function measure identifies high-risk individuals.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Left ventricular outflow tract velocity time integral (LVOT VTI) assesses cardiac systolic function and output.
- Low cardiac output in heart failure patients correlates with poor cardiovascular outcomes.
- Extremely low LVOT VTI may signify heightened mortality risk in heart failure.
Purpose of the Study:
- To investigate the predictive value of extremely low LVOT VTI for adverse outcomes in heart failure patients.
- To identify specific clinical variables associated with mortality and LVAD implantation in this cohort.
Main Methods:
- Retrospective analysis of heart failure patients with extremely low LVOT VTI from a single-center database.
- Collection of baseline characteristics and 12-month clinical outcomes (death, LVAD).
- Correlation analysis of LVOT VTI, ejection fraction (EF), pulmonary artery systolic pressure (PASP), and cardiac output (CO) with clinical endpoints.
Main Results:
- A cohort of 100 patients was analyzed, with 30 events (28 deaths, 2 LVADs) at 12 months.
- Lower LVOT VTI was significantly associated with death and LVAD implantation (p=0.039), unlike EF or CO.
- Multivariate analysis confirmed LVOT VTI (p=0.003), age, and PASP as significant predictors of adverse outcomes.
Conclusions:
- Extremely low LVOT VTI is a strong predictor of adverse outcomes in heart failure.
- This finding identifies patients who could benefit from advanced heart failure therapies.
- LVOT VTI serves as a critical prognostic indicator in heart failure management.
Background:
Left ventricular outflow tract velocity time integral (LVOT VTI) is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure patients at highest risk for mortality.
Methods:
Patients with heart failure and extremely low LVOT VTI were identified from a single-center database. Baseline characteristics and heart failure related clinical outcomes (death, LVAD) were obtained at 12 months. Correlation between clinical endpoints and the following variables were analyzed: ejection fraction (EF), pulmonary artery systolic pressure (PASP), NYHA class, renal function, Doppler cardiac output (CO), and LVOT VTI.
Results:
Study cohort consisted of 100 patients. At the 12-month follow up period, 30 events (28 deaths, 2 LVADs) were identified. Occurrence of death and LVAD implantation was statistically associated with a lower LVOT VTI (p = 0.039) but not EF (p = 0.169) or CO (p = 0.217). In multivariate analysis, LVOT VTI (p = 0.003) remained statistically significant, other significant variables were age (p = 0.033) and PASP (p = 0.022). Survival analysis by LVOT VTI tertile demonstrated an unadjusted hazard ratio of 4.755 (CI 1.576-14.348, p = 0.006) for combined LVAD and mortality at one year.
Conclusions:
Extremely low LVOT VTI strongly predicts adverse outcomes and identifies patients who may benefit most from advanced heart failure therapies.
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