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[Prognostic importance of pseudonormalized left ventricular inflow pattern especially for sudden cardiac death]
H Tabuchi1, N Kawai, T Sawayama
1Division of Cardiology, Seikeikai Hospital, Sakai.
Insights
Persistent pseudonormalized left ventricular inflow patterns in heart failure patients indicate a poorer prognosis. Transient patterns suggest a better survival outlook, highlighting the importance of monitoring these Doppler-derived velocities.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Pathophysiology
Background:
- Assessing prognostic indicators in congestive heart failure (CHF) is crucial for patient management.
- Left ventricular (LV) inflow patterns, particularly pseudonormalization, require further investigation for their prognostic significance.
Observation:
- This study analyzed 32 CHF patients with initially pseudonormalized LV inflow patterns using pulsed Doppler echocardiography.
- Patients were categorized into persistent (21) and transient (11) pseudonormalized groups based on follow-up patterns.
- Key differentiating factors included cardiogenic shock and LV end-diastolic wall stress.
Findings:
- The persistent pseudonormalized group had a 2-year survival rate of 37%, significantly lower than the transient group's 82%.
- Increased LV end-diastolic wall stress was noted in the persistent group, potentially linked to reduced preload reserve.
- Sudden cardiac death in two patients was preceded by atrial fibrillation and atrioventricular dissociation.
Implications:
- Monitoring pseudonormalized LV inflow patterns via pulsed Doppler is a sensitive indicator for CHF management.
- Identifying persistent pseudonormalization may help stratify high-risk patients needing closer surveillance.
- Understanding triggers for sudden death, like arrhythmias, is vital for preventing adverse outcomes in CHF.
Abstract:
The prognostic value of left ventricular inflow velocities by the pulsed Doppler method was studied in 32 patients with congestive heart failure including 18 with old myocardial infarction, 9 with dilated cardiomyopathy, and 5 with hypertensive heart disease, who initially revealed pseudonormalized left ventricular inflow pattern. Pulsed Doppler echocardiography, apexcardiography, and phonocardiography were performed at 3- to 9-month intervals. The prognosis was evaluated for two groups of patients with persistent or transient pseudonormalized inflow patterns. Survival rates at 6 months and 2 years in the total patient population were 78% and 47%, respectively. Twenty-one patients had the pseudonormalized left ventricular inflow pattern (persistent group), while the other 11 patients had a changed pattern (transient group). The survival rate at 2 years was 37% for the persistent group, and 82% for the transient group. Significant differences in patient profiles and the initial data between the two patient groups were the presence of cardiogenic shock (10/21 in persistent group vs 1/11 in transient group; p < 0.001) and the value of left ventricular end-diastolic wall stress (159 +/- 62 g/cm2 in persistent group vs 135 +/- 42 g/cm2 in transient group; p < 0.05). There were no significant differences in NYHA class, the values of left ventricular end-diastolic pressure, left ventricular ejection fraction. A/E ratio, or deceleration half time of left ventricular inflow velocities. Left ventricular end-diastolic wall stress in patients with persistent pseudonormalized left ventricular inflow pattern was significantly increased, and may be related to decreased preload reserve. Atrial fibrillation and atrioventricular dissociation were recorded prior to the development of ventricular fibrillation in two patients with sudden cardiac death. Abrupt loss of atrial contribution as well as ventricular arrhythmias may be a trigger of sudden death. Evaluation and follow-up of the pseudonormalized left ventricular inflow pattern is a sensitive indicator for the management of patients with congestive heart failure.