Loading Manipulations Improve the Prognostic Value of Doppler Evaluation of Mitral Flow in Patients With Chronic Heart Failure

Pozzoli, Massimo; Traversi, Egidio; Cioffi, Giovanni; Stenner, Rachel; Sanarico, Maurizio; Tavazzi, Luigi

doi:10.1161/01.cir.95.5.1222

Cited by 158 publications

(83 citation statements)

References 24 publications

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“…In ACHF, the most severe pattern of diastolic dysfunction is restrictive filling which is characterised by a very high mitral E/A ratio (N 2) and a short mitral DT (b 140 ms). This pattern reliably predicts a poor prognosis, especially if it persists after preload reduction [24].…”

Section: Diastolic Functionmentioning

confidence: 89%

“…Useful prognostic indicators are outlined in Table 2 [1,2,7,8,10,[19][20][21]24,28,31,32,[37][38][39][40]. Signs of increased LV filling pressure and/or of right ventricular dysfunction, assessed by Dopplerechocardiography or cardiac catheterisation, are more important in ACHF with a greater predictive power when these data are collected after optimisation of therapy [6,24,41]. Riskstratification models have been developed and validated both in patients referred for Htx and in those hospitalised for HF.…”

Section: Assessment Of Prognosismentioning

confidence: 99%

See 1 more Smart Citation

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

357

242

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Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition.Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction b 30%, pseudonormal or restrictive mitral inflow pattern at Dopplerechocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance b 300 m or a peak oxygen uptake b 12-14 ml/kg/min; 5) history of N1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.

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Section: Diastolic Functionmentioning

confidence: 89%

Section: Assessment Of Prognosismentioning

confidence: 99%

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

357

242

View full text Add to dashboard Cite

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“…[30][31][32] Angiotensinconverting enzyme inhibitors may favorably affect prognosis in these cases; 33 increase in the duration of the mitral deceleration time through physiologic or pharmacologic tests predicts more favorable prognosis in patients with systolic heart failure. 34 Temporelli et al 35 proposed that reversibility of restrictive LV filling in response to optimized therapy should be included in the noninvasive prognostication of patients with chronic heart failure. Among other indices of adverse outcome in heart failure, RV dimension, LV dimension and geometry, and reduced peak VO2 are powerful indices of poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Effects of acute angiotensin‐converting enzyme inhibition on diastolic ventricular interaction in the dilated heart

Pepi

Tamborini

Maltagliati

et al. 2003

Clinical Cardiology

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SummaryBackground: The normal and dilated heart behaves as a single functional unit during preload reduction; volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling.Hypothesis: We hypothesized that reduction of venous return induced by a physiologic stimulus (tilting) or by acute angiotensin-converting enzyme (ACE) inhibitors in dilated heart is likely to have a marked and similar effect on ventricular chamber geometry and filling. This study was designed to assess how the normal and dilated heart adapts to preload reduction.Methods: Twenty normal subjects and 20 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position (B) and after 40˚ of head-up tilting (T). The following day, patients repeated supine (C) and tilting test (TC) after administration of captopril (25 mg s.l.). Right ventricular (RV) and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study.Results: In the two groups, T was associated with reduction of RV area and LV volumes; C and TC produced a similar effect on RV and LV. Changes in LV septal-lateral diameter and anterior-posterior diameter were different at each step of the study: during T (both groups) and after C and TC, the septallateral diameter increased slightly while the anterior-posterior diameter decreased. During T, mitral and tricuspid peak flow velocities decreased, peak late velocities were unchanged, and the deceleration time of mitral flow increased; the systolic for-

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“…The ratio of early-to-late filling velocities (E/A) was then calculated. A restrictive filling pattern was diagnosed when the Dct <150 ms. 14,15 As with impaired LV function, the presence of LV thrombus and aneurysm were also evaluated.…”

Section: Measurement Of LV Function In the Chronic Phasementioning

confidence: 99%

Long-Term Beneficial Effect of Infarct-Related Artery Patency in Acute Anterior Myocardial Infarction in Patients With Poor Myocardial Viability in the Region-at-Risk

Fukuda

Yoshiyama

Shimada

et al. 2004

Circ J

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Background Several studies have demonstrated the benefit of the patency of infarct-related artery (IRA) in acute myocardial infarction (AMI). However those studies have not been concerned with myocardial viability in the region-at-risk. In the present study the effect of the patency of IRA was investigated in the setting of anterior AMI with poor viable myocardium in the risk region. Methods and ResultsFrom 1993 to 1996 patients with a first time anterior AMI and poor viable myocardium in the region-at-risk at 1 month after onset were identified and enrolled. Patients with a totally occluded IRA were included in the Non-Open group (n=44), and patients with a reperfused IRA were included in the Open group (n=49). At 5 years after onset, left ventricular function was better preserved in the Open group than in the Non-Open group (p<0.05). Kaplan-Meier survival curves for cardiac mortality and event-free survival curves revealed poor prognoses in the Non-Open group over a 5-year period (p<0.05, respectively). The advantages of a patent IRA were further seen in health-related quality-of-life outcomes (p<0.05). Conclusions Even in patients with poor myocardial viability after an anterior AMI, the patency of the IRA is strongly associated with improved long-term survival, independent of residual myocardium viability. (Circ J 2004; 68: 1110 -1116

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Loading Manipulations Improve the Prognostic Value of Doppler Evaluation of Mitral Flow in Patients With Chronic Heart Failure

Abstract: In patients with chronic heart failure, MFVPs provide independent prognostic information. Their prognostic value can be further increased by assessment of the changes induced in them by loading manipulations.

Cited by 158 publications

References 24 publications

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Effects of acute angiotensin‐converting enzyme inhibition on diastolic ventricular interaction in the dilated heart

Long-Term Beneficial Effect of Infarct-Related Artery Patency in Acute Anterior Myocardial Infarction in Patients With Poor Myocardial Viability in the Region-at-Risk

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