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Predictive value of M-mode echocardiography in patients with congestive heart failure
Insights
M-mode echocardiograms (ECHO) can predict survival in congestive heart failure (CHF) patients. However, ECHO measurements do not reliably predict exercise capacity (VOmax) in this population.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- M-mode echocardiography (ECHO) is commonly used for monitoring patients with congestive heart failure (CHF).
- The prognostic value of ECHO in CHF patients remains incompletely understood.
Purpose of the Study:
- To evaluate the utility of baseline M-mode echocardiography (ECHO) in predicting 1-year survival and maximal oxygen uptake (VOmax) in patients with symptomatic congestive heart failure (CHF).
Main Methods:
- Echocardiograms were performed on 49 patients with symptomatic CHF (12 due to coronary artery disease, 37 to idiopathic dilated cardiomyopathy).
- Left ventricular contractility indices (shortening fraction, velocity of circumferential fiber shortening) and dimensions were assessed.
- Correlation with 1-year mortality and VOmax was analyzed.
Main Results:
- Overall 1-year mortality was 20%, significantly higher in coronary artery disease (42%) versus idiopathic dilated cardiomyopathy (14%) patients.
- Echocardiographic indices of left ventricular contractility, specifically shortening fraction and velocity of circumferential fiber shortening, were significantly higher in survivors compared to non-survivors.
- No significant differences were found in left ventricular dimensions between survivors and non-survivors.
- No ECHO parameters correlated significantly with VOmax.
Conclusions:
- M-mode echocardiography (ECHO) shows potential utility in predicting survival in patients with congestive heart failure (CHF).
- ECHO-derived measures of left ventricular contractility are associated with survival outcomes.
- ECHO is not a reliable predictor of functional capacity (VOmax) in CHF patients.
Abstract:
The M-mode echocardiogram (ECHO) is widely used to follow patients with congestive heart failure (CHF), but the value of ECHO for this purpose is unclear. In 49 patients with symptomatic CHF, we obtained ECHO during baseline evaluation to determine the value of ECHO for predicting 1-year survival or maximal oxygen uptake during exercise (VOmax). The cause of CHF was coronary artery disease in 12 patients and idiopathic dilated cardiomyopathy in 37 patients. Overall mortality at 1 year was 10 of 49 (20%), but was higher in patients with coronary artery disease (42%) compared to those with idiopathic dilated cardiomyopathy (14%), p less than 0.001. ECHO indices of left ventricular contractility were greater in survivors (S) in whom shortening fraction averaged 16 +/- 8 (SD)% vs 10 +/- 4% in nonsurvivors (NOS), p less than 0.025. Velocity of circumferential fiber shortening averaged 0.53 +/- 0.25 Hz in S vs 0.35 +/- 0.15 Hz in NOS, p less than 0.05. No left ventricular dimensions, including systolic and diastolic diameters, volume, wall thickness, and mass differed significantly between S and NOS. No ECHO measure of left ventricular dimensions or contractility correlated significantly with VOmax. Thus, ECHO may be useful to predict survival but not functional capacity in patients with CHF.