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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Incremental prognostic value of echocardiography of left ventricular remodeling and diastolic function in STICH trial
Kyung-Hee Kim1,2, Lilin She3, Kerry L Lee3
1Division of Cardiovascular Diseases, Sejong General Hospital, Bucheon, South Korea.
Insights
Echocardiographic markers like LV end-systolic volume index and E/A ratio provide significant prognostic information for ischemic heart failure patients. These measures, particularly an E/A ratio near 0.8, improve risk assessment beyond current clinical factors.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Ischemic heart failure with systolic dysfunction poses significant mortality risks.
- Current clinical markers may not fully capture prognosis.
- Echocardiographic assessment of left ventricular (LV) remodeling and diastolic function is crucial.
Purpose of the Study:
- To evaluate echocardiographic markers of LV remodeling and diastolic dysfunction.
- To determine their incremental and independent prognostic value in ischemic LV systolic dysfunction.
- To compare their predictive power against established clinical risk factors within the STICH trial.
Main Methods:
- Analysis of 1511 patients from the STICH trial with baseline transmitral Doppler (E/A ratio) measurements.
- Utilized a Cox regression model to assess the prognostic value of echocardiographic variables.
- Developed a clinical multivariable model incorporating creatinine, LVESVI, age, and E/A ratio.
Main Results:
- The E/A ratio was the most significant diastolic predictor of mortality, with the lowest risk observed for ratios closest to 0.8.
- Mortality risk increased for E/A ratios below 0.6 and above 1.0.
- Larger LV end-systolic volume index (LVESVI) and abnormal E/A ratios ( <0.6 or >1.0) incrementally worsened prognosis.
- LVESVI and E/A ratio were stronger predictors than NYHA class, anemia, diabetes, atrial fibrillation, and stroke.
- Creatinine, LVESVI, age, and E/A ratio explained 74% of the prognostic information.
Conclusions:
- Echocardiographic markers of advanced LV remodeling and diastolic dysfunction offer significant incremental prognostic value.
- LVESVI and E/A ratio are superior predictors of risk in ischemic heart failure compared to other clinical markers.
- An E/A ratio closest to 0.8 represents the optimal diastolic filling pattern for risk assessment.
Aims:
We sought to determine which echocardiographic markers of left ventricular (LV) remodeling and diastolic dysfunction can contribute as incremental and independent prognostic information in addition to current clinical risk markers of ischemic LV systolic dysfunction in the Surgical Treatment for Ischemic Heart Failure (STICH) trial.
Methods And Results:
The cohort consisted of 1511 of 2136 patients in STICH for whom baseline transmitral Doppler (E/A ratio) could be measured by an echocardiographic core laboratory blinded to treatment and outcomes, and prognostic value of echocardiographic variables was determined by a Cox regression model. E/A ratio was the most significant predictor of mortality amongst diastolic variables with lowest mortality for E/A closest 0.8, although mortality was consistently low for E/A 0.6 to 1.0. Mortality increased for E/A < 0.6 and > 1.0 up to approximately 2.3, beyond which there was no further increase in risk. Larger LV end-systolic volume index (LVESVI) and E/A < 0.6 and > 1.0 had incremental negative effects on mortality when added to a clinical multivariable model, where creatinine, LVESVI, age, and E/A ratio accounted for 74% of the prognostic information for predicting risk. LVESVI and E/A ratio were stronger predictors of prognosis than New York Heart Association functional class, anemia, diabetes, history of atrial fibrillation, and stroke.
Conclusions:
Echocardiographic markers of advanced LV remodeling and diastolic dysfunction added incremental prognostic value to current clinical risk markers. LVESVI and E/A ratio outperformed other markers and should be considered as standard in assessing risks in ischemic heart failure. E/A closest to 0.8 was the most optimal filling pattern.
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