Independence of restrictive filling pattern and LV ejection fraction with mortality in heart failure: An individual patient meta‐analysis

Doughty, R.; Al, Klein; Kk, Poppe; Gamble, Greg; Dini, Fl; Møller, Jacob Eifer; Quintana, Miguel; Yu, CM; Whalley, Gillian A.

doi:10.1016/j.ejheart.2008.06.005

Cited by 69 publications

(19 citation statements)

References 47 publications

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“…However, the included patients did not differ from the excluded patients with respect to important clinical variables (internal validity acceptable) and selection bias would only appear if the associations between eGFR and RF or the associations between eGFR or RF and mortality risk were different in the excluded patients, which seems unlikely. Furthermore, the prognostic significance of RF and eGFR is in accordance with other studies (external validity acceptable) [1,38,39]. We used eGFR as estimate for GFR, and we did not analyze s-creatinine in a core lab, and this could lead to analytical variation.…”

Section: Discussionsupporting

confidence: 67%

Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure: a 7-year follow-up study

et al. 2013

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BackgroundRenal dysfunction is associated with a variety of cardiac alterations including left ventricular (LV) hypertrophy, LV dilation, and reduction in systolic and diastolic function. It is common and associated with an increased mortality risk in heart failure (HF) patients. This study was designed to evaluate whether severe diastolic dysfunction contribute to the increased mortality risk observed in HF patients with renal dysfunction.MethodsUsing Cox Proportional Hazard Models on data (N = 669) from the EchoCardiography and Heart Outcome Study (ECHOS) study we evaluated whether estimated glomerular filtration rate (eGFR) was associated with mortality risk before and after adjustment for severe diastolic dysfunction. Severe diastolic dysfunction was defined by a restrictive left ventricular filling pattern (RF) (=deceleration time < 140 ms) by Doppler echocardiography.ResultsMedian eGFR was 58 ml/min/1.73 m2, left ventricular ejection fraction was 33% and RF was observed in 48%. During the 7 year follow up period 432 patients died. Multivariable adjusted eGFR was associated with similar mortality risk before (Hazard Ratio(HR)eGFR 10 ml increase: 0.94 (95% CI: 0.89-0.99, P = 0.024) and after (HReGFR 10 ml increase: 0.93 (0.89-0.99), P = 0.012) adjustment for RF (HR: 1.57 (1.28-1.93), P < 0.001).ConclusionsIn patients admitted with HF RF does not contribute to the increased mortality risk observed in patients with a decreased eGFR. Factors other than severe diastolic dysfunction may explain the association between renal function and mortality risk in HF patients.

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Section: Discussionsupporting

confidence: 67%

Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure: a 7-year follow-up study

et al. 2013

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“…Increased LV stiffness reduces the preload reserve and may contribute to elevated filling pressures and limitation of exercise capacity [50, 52]. Restrictive filling which occurs in the advanced stage of diastolic dysfunction predicts a poor prognosis [11]. It is hoped that noninvasive measurements of myocardial stiffness may facilitate earlier detection of changes with pathology and may allow monitoring the effect of medical therapies.…”

Section: Discussionmentioning

confidence: 99%

Wave propagation of myocardial stretch: correlation with myocardial stiffness

2014

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The mechanism of flow propagation during diastole in the left ventricle (LV) has been well described. Little is known about the associated waves propagating along the heart wall s. These waves may have a mechanism similar to pulse wave propagation in arteries. The major goal of the study was to evaluate the effect of myocardial stiffness and preload on this wave transmission. Methods Longitudinal late diastolic deformation and wave speed (Vp) of myocardial stretch in the anterior LV wall were measured using sonomicrometry in sixteen pigs. Animals with normal and altered myocardial stiffness (acute myocardial infarction) were studied with and without preload alterations. Elastic modulus estimated from Vp (EVP; Moens-Korteweg equation) was compared to incremental elastic modulus obtained from exponential end -diastolic stress-strain relation (ESS). Myocardial distensibility and α-and β-coefficients of stress-strain relations were calculated. Results Vp was higher at reperfusion compared to baseline (2.6±1.3 m/s vs. 1.3±0.4 m/s; p=0.005) and best correlated with ESS (r 2=0.80, p<0.0001), β-coefficient (r2=0.78, p<0.0001), distensibility (r2=0.47, p=0.005), and wall thickness/diameter ratio (r2=0.42, p=0.009). Elastic moduli (EVP and ESS) were strongly correlated (r2=0.83, p<0.0001). Increasing preload increased Vp and EVP and decreased distensibility. At multivariate analysis, ESS, wall thickness, and end-diastolic and systolic LV pressures were independent predictors of Vp (r2model=0.83, p<0.0001). Conclusions The main determinants of wave propagation of longitudinal myocardial stretch were myocardial stiffness and LV geometry and pressure. This local wave speed could potentially be measured noninvasively by echocardiography.

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“…Thus, the meta-analysis research group in echocardiography heart failure meta-analysis, which included data of 3540 patients from 18 studies, revealed a mean patient age of 62 ± 13 years. [16] Perhaps, the younger patient age in our study population could be explained by the fact that patients with severe LV systolic dysfunction were not included in our study that might have been in more advanced age. The second explanation might be that our sample patient population reflects the overall age demographics in Kosovo, where around 50% of population represents those <24 years of age.…”

Section: Discussionmentioning

confidence: 99%

Lower body weight in men, an epidemiological predictor of enlarged left atrium in sinus rhythm patients with dilated heart

Bakalli

Georgievska-Ismail

Musliu

et al. 2016

J Cardiovasc Echography

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Background/Aims:The source of thrombi in patients with dilated cardiomyopathy is not necessarily from the dilated left ventricle. Left atrium (LA) and left atrial appendage (LAA) might be in charge for relatively high rate of systemic embolizations in these patients. The main aim of our study was to identify epidemiological predictors in sinus rhythm patients with dilated heart for LA and LAA dilation and/or dysfunction.Patients and Methods:This was a prospective cross-sectional study conducted from 2009 to 2014 in 101 sinus rhythm patients with dilated heart. We excluded patients with swallowing problems, acute myocardial infarction, atrial fibrillation/flutter, severe systolic dysfunction, mechanical valves, oral anticoagulation therapy, and/or patients with a history of stroke/systemic thromboembolic event.Results:Mean patient age was 58.13 ± 12.66 years and 69.3% were men. Hypertension was encountered in 51% of our patients, 56% of them had a history of coronary artery disease, 30% had diabetes, 25% had dyslipidemia, 30% were smokers, whereas 10% were alcoholics. Mean LA dimensions resulted higher than reference values, whereas 86% of our patients had LAA dysfunction. Male gender was an independent predictor for LA diameter dilation (95% confidence interval [CI]: 1.765–9.078, P = 0.005), while lower body weight was a predictor for enlargement of LA area (95% CI: 0.044–0.351, P = 0.014) and LA volume (95% CI: 0.160–2.067, P = 0.024).Conclusion:Male patients with dilated cardiomyopathy at sinus rhythm with lower body weight tend to have larger LA and consequently might be at higher risk of developing atrial thrombus and its subsequent consequences.

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Independence of restrictive filling pattern and LV ejection fraction with mortality in heart failure: An individual patient meta‐analysis

Abstract: The restrictive mitral filling pattern is a powerful predictor of mortality, independent of LVEF and age, in patients with HF. Doppler-derived LV filling patterns are an accessible marker from echocardiography that can readily be incorporated in risk stratification of all patients with HF.

Cited by 69 publications

References 47 publications

Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure: a 7-year follow-up study

Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure: a 7-year follow-up study

Wave propagation of myocardial stretch: correlation with myocardial stiffness

Lower body weight in men, an epidemiological predictor of enlarged left atrium in sinus rhythm patients with dilated heart

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