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Updated: May 7, 2026
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Tissue Doppler echocardiography predicts long-term cardiovascular mortality: the Anglo-Scandinavian Cardiac Outcomes
Anenta Ratneswaren1, Tong Wu1, Amit Kaura1
1National Heart and Lung Institute, Imperial College London, London, UK.
Insights
Tissue Doppler echocardiography measurements of left ventricular diastolic function predict long-term cardiovascular mortality in hypertensive patients. Impaired function indicated by reduced e
Area of Science:
- Cardiology
- Echocardiography
- Hypertension Research
Background:
- Left ventricular diastolic function assessed by tissue Doppler echocardiography predicts cardiovascular events in hypertensive patients at 4 years.
- The long-term prognostic value of these echocardiographic measures for cardiovascular mortality remains to be fully elucidated.
Purpose of the Study:
- To determine if tissue Doppler echocardiography assessment of left ventricular diastolic function predicts cardiovascular mortality over a 20-year follow-up period in hypertensive patients.
Main Methods:
- Tissue Doppler echocardiography (E and e') performed on 506 hypertensive participants in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).
- Long-term cardiovascular mortality ascertained via linkage to the Office of National Statistics.
- Cox regression survival models used to analyze the association between echocardiographic measurements and cardiovascular mortality.
Main Results:
- Over 20 years, 200 deaths occurred, with 60 (12%) being cardiovascular-related.
- A reduction in e' was independently associated with increased cardiovascular mortality (HR 1.22 per 1 cm/s decrease).
- A higher E/e' ratio was independently associated with increased cardiovascular mortality (HR 1.12 per 1-unit increase).
Conclusions:
- Impaired left ventricular diastolic function, assessed by tissue Doppler echocardiography (e' and E/e'), independently predicts cardiovascular mortality over 20 years in hypertensive patients.
- These findings highlight the significant long-term prognostic value of diastolic function assessment in this population.
Background:
Left ventricular diastolic function as assessed by tissue Doppler echocardiography predicts cardiovascular event rates at 4 years of follow-up in patients with hypertension. Our aim was to evaluate whether this extends to predicting cardiovascular mortality after 20 years of follow-up.
Methods:
Conventional (E) and tissue Doppler (e') echocardiography was performed on hypertensive participants in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) with long-term follow-up ascertained via linkage to the Office of National Statistics. Cardiovascular mortality was defined as death from coronary heart disease, stroke and other cardiovascular aetiology such as heart failure or peripheral vascular disease. Unadjusted and adjusted Cox regression survival models were constructed to investigate the association between tissue Doppler echocardiography measurements and long-term cardiovascular mortality.
Results:
Among 506 hypertensive patients (median age 64, interquartile range (58, 69), 87% male), there were 200 (40%) deaths over a 20-year follow-up period. 60 deaths (12%) were cardiovascular-related.A reduction in e' was independently associated with increased cardiovascular mortality, after adjusting for the ACC/AHA Atherosclerotic Cardiovascular Disease (ASCVD) risk score, with an inverse HR of 1.22 per 1 cm/s decrease (95% CI 1.04-1.43). A higher E/e' ratio was independently associated with increased cardiovascular mortality, after adjusting for the ASCVD risk score, with an HR of 1.12 per 1-unit increase (95% CI, 1.02 to 1.23).
Conclusions:
Impaired left ventricular diastolic function, measured using tissue Doppler echocardiography through e' and E/e', independently predicts increased cardiovascular mortality over 20 years in hypertensive patients, highlighting its long-term prognostic significance.
