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Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure
1Division of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington 40536-0084.
Insights
Doppler echocardiography can predict cardiac death in congestive heart failure patients. A restrictive transmitral flow pattern, identified via Doppler, is the strongest clinical predictor of mortality in these patients.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Doppler transmitral flow patterns correlate with functional class and exercise capacity in heart failure.
- Prognostic significance of these Doppler flow patterns in heart failure remained unknown.
Purpose of the Study:
- To determine if Doppler echocardiographic transmitral flow patterns predict cardiac mortality in congestive heart failure patients.
- To assess the prognostic value of transmitral flow patterns in heart failure.
Main Methods:
- 100 congestive heart failure patients (left ventricular ejection fraction < 40%) underwent Doppler echocardiography.
- Transmitral flow patterns were analyzed, classifying patients into restrictive or non-restrictive groups based on E/A ratio and deceleration time.
- Cardiac mortality was tracked over a mean follow-up of 16 months.
Main Results:
- Cardiac mortality was significantly higher in the restrictive transmitral flow group compared to the non-restrictive group at 1 and 2 years.
- Restrictive flow pattern, female gender, and advanced New York Heart Association functional class were significant predictors of cardiac mortality.
- The restrictive transmitral flow pattern demonstrated a relative risk of 4.1 at 1 year and 8.6 at 2 years for cardiac death.
Conclusions:
- A restrictive transmitral flow pattern, identified by Doppler echocardiography, is a powerful predictor of cardiac mortality in congestive heart failure.
- Female gender and advanced functional class also predict higher cardiac mortality in this population.
- Doppler-derived restrictive transmitral flow pattern emerges as the leading clinical predictor for cardiac death in heart failure.
Objectives:
This study was designed to determine whether Doppler echocardiographic transmitral flow patterns can predict cardiac mortality in patients with congestive heart failure.
Background:
Previous studies have indicated that Doppler transmitral flow patterns are related to New York Heart Association functional class and exercise capacity in patients with congestive heart failure. However, the prognostic significance of these flow patterns is not known.
Methods:
We analyzed the relation of transmitral flow patterns and cardiac mortality in 100 consecutive patients (76 men, 24 women; mean [+/- SD] age 60 +/- 11 years) with congestive heart failure symptoms and left ventricular ejection fraction < 40%. At the time of entry into the study, functional class and ejection fraction by radionuclide angiography were determined, and Doppler echocardiography was performed in all patients. Transmitral flow was obtained from the apical four-chamber view at the mitral annulus level. Measurements included early (E) and atrial (A) filling velocities, E/A ratio and deceleration time of the E wave. The patients were assigned to two groups according to E/A ratio or deceleration time of transmitral flow patterns, or both: a non-restrictive group (42 patients) with E/A < or = 1 or E/A = 1 to 2 and deceleration time > 140 ms, and a restrictive group (58 patients) with E/A > or = 2 or E/A = 1 to 2 and deceleration time < or = 140 ms.
Results:
Of 100 patients, 26 died during a mean follow-up period of 16 +/- 8 months. The cumulative cardiac mortality rate determined by the Kaplan-Meier method was 14% at 1 year and 35% at 2 years. Cox proportional hazards model analysis revealed that transmitral flow (restrictive vs. nonrestrictive, chi-square 6.99, p = 0.008), patient gender (female vs. male, chi-square 4.59, p = 0.03) and New York Heart Association functional class (IV vs. II, chi-square 3.95, p = 0.05) were significantly related to cardiac mortality in patients with congestive heart failure. Mortality rate in the restrictive group was markedly higher than that in the nonrestrictive group at 1 year (19% vs. 5%, respectively, p < 0.05) and at 2 years (51% vs. 5%, respectively, p < 0.01) by log-rank test. Relative risk for cardiac death was estimated as 4.1 at 1 year and 8.6 at 2 years in the restrictive group compared with the nonrestrictive group.
Conclusions:
In patients with congestive heart failure, a restrictive transmitral flow pattern, female gender and advanced functional class are predictive of higher cardiac mortality. The restrictive transmitral flow pattern by Doppler echocardiography is the single best clinical predictor for cardiac death in patients with congestive heart failure.