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High-frequency High-resolution Echocardiography: First Evidence on Non-invasive Repeated Measure of Myocardial Strain, Contractility, and Mitral Regurgitation in the Ischemia-reperfused Murine Heart
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Prognostic relevance of Doppler echocardiographic re-assessment in HFrEF patients

Stefano Ghio1, Erberto Carluccio2, Angela Beatrice Scardovi3

  • 1Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.

International Journal of Cardiology
|November 21, 2020
PubMed

Insights

Periodic echocardiograms in stable heart failure with reduced ejection fraction (HFrEF) patients offer valuable prognostic insights. Re-assessing cardiac function and hemodynamics improves survival prediction beyond current guidelines.

Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Current guidelines do not advocate for routine repeat echocardiograms in stable heart failure with reduced ejection fraction (HFrEF) patients.
  • The prognostic value of serial echocardiographic assessments in this population remains under-investigated.

Purpose of the Study:

  • To evaluate the added prognostic information from comprehensive Doppler echocardiographic re-assessment of cardiac function and hemodynamics in stable HFrEF outpatients.
  • To determine if serial echocardiography improves risk stratification beyond baseline evaluation and clinical parameters.

Main Methods:

  • Retrospective analysis of 769 stable HFrEF outpatients with baseline and follow-up echocardiograms.
  • Key prognostic predictors assessed: left ventricular (LV) filling pattern, pulmonary artery systolic pressure (PASP), and right ventricular function (TAPSE).
  • All-cause death was the primary endpoint, with a median follow-up of 30 months.

Main Results:

  • Baseline restrictive filling pattern and low TAPSE predicted poor prognosis.
  • At re-evaluation, persistently abnormal LV filling, TAPSE, and worsened PASP were associated with reduced survival.
  • A novel interaction between changes in TAPSE, PASP, and LV filling pattern significantly impacted survival, improving model discrimination (C-index from 0.69 to 0.74).

Conclusions:

  • Serial Doppler echocardiography reassessment of LV filling, PASP, and TAPSE provides superior prognostic stratification for HFrEF outpatients compared to baseline evaluation.
  • This approach offers incremental prognostic value beyond changes in B-type natriuretic peptide (BNP) and New York Heart Association (NYHA) class.
Abstract

Keywords:
EchocardiographyHeart failurePrognosis

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