Cardiac Dysfunction Assessed by Echocardiographic Tissue Doppler Imaging Is an Independent Predictor of Mortality in the General Population

Abstract

Background-Tissue Doppler imaging (TDI) detects left ventricular dysfunction in patients with heart failure and normal ejection fraction, but the prognostic significance of left ventricular dysfunction by TDI in the general population is unknown. Methods and Results-Within the Copenhagen City Heart Study, a large community-based population study, cardiac function was evaluated in 1036 participants by both conventional echocardiography and TDI. Averages of peak systolic (sЈ), early diastolic (eЈ), and late diastolic (aЈ) velocities from 6 mitral annular sites were used. TDI was furthermore quantified by a combined index (eas index) of diastolic and systolic performance: eЈ/(aЈϫsЈ). During follow-up (median, 5.3 years), 90 participants died. Left ventricular dysfunction by TDI, in terms of low sЈ (hazard ratio, 1.23 per 1-cm/s decrease; PϽ0.05) and aЈ (hazard ratio, 1.20 per 1-cm/s decrease; Pϭ0.001), were significant predictors of death in Cox proportional-hazards models adjusted for clinical variables (age, sex, body mass index, heart rate, hypertension, diabetes mellitus, and ischemic heart disease) and conventional echocardiography. The adjusted hazard ratio for death in the third tertile compared with the first tertile of the combined index of systolic and diastolic performance by TDI was 2.5 (PϽ0.005). Conclusions-In

Influência da aterosclerose subclínica na função diastólica em indivíduos sem doença cardiovascular

“…Tissue Doppler indices were: peak systolic motion velocity, peak early diastolic motion velocity (E'), peak atrial systolic motion velocity (A') and the E'/A' ratio. The known negative correlation between E' and A' reflects the internal dependency between these parameters and supports their analysis together, not individually 15 . The E/E' ratio was not selected for these analyses, as it is not a robust measurement in healthy subjects with preserved ejection fraction 16 .…”

Decreased regional left ventricular myocardial strain in type 1 diabetic children: a first sign of diabetic cardiomyopathy?

“…Overall, 30 consecutive children and adolescents with type 1 diabetes (age range [5][6][7][8][9][10][11][12][13][14][15][16][17] years, male: 53%) were recruited at our pediatric endocrinology department and enrolled in this prospective cohort. Among children with diabetes, HBA 1c ranged from 6.8% to 12.7% , 63% of the patients with diabetes patients had HBA 1C > 8 % and mean diabetes duration was 5.1 ± 3.1 years.…”

“…Strain and strain rate, derived from tissue Doppler imaging (TDI), have been proposed as parameters for the early detection of myocardial dysfunction [11] . This technique can detect subclinical changes in myocardial function and represent an independent prognostic factor [12] . Our study investigates (1) whether children with type 1 diabetes have echocardiographic signs of subclinical cardiac dysfunction assessed by color tissue Doppler imaging and (2) whether the state of metabolic control and diabetes duration have an influence on the cardiac event.…”

Fator de diferenciação de crescimento 15: um novo biomarcador em pacientes com disfunção diastólica?

“…Recent data suggest that overall mortality due to HFnEF is equivalent to that of systolic heart failure (SHF) 1,2 . In the general population, asymptomatic left ventricular diastolic dysfunction (LVDD), which is considered as a precursor of HFnEF 3 , is a powerful and independent predictor of death 4 .…”