Prognostic Value of a Simple Echocardiographic Parameter, the Right Ventricular Systolic to Diastolic Duration Ratio, in Patients with Advanced Heart Failure with Non-Ischemic Dilated Cardiomyopathy

Abstract

The prognostic value of the right ventricular (RV) systolic to diastolic duration ratio (S/D ratio) in patients with advanced heart failure is not clear.We enrolled 45 patients with DCM (40 ± 13 years, 33 male) who were admitted to our hospital for evaluation or treatment of heart failure. The RV systolic and diastolic durations were measured using continuous Doppler imaging of tricuspid regurgitation, and the RV S/D ratio was calculated. Cardiac events were defined as cardiac death or left ventricular assist device implantation within the first year. Twenty-eight cardiac events occurred. The RV S/D ratio was significantly higher in the event group than in the event-free group (1.8 ± 0.8 versus 1.2 ± 0.5, P = 0.008). Univariate analysis showed that the RV S/D ratio, plasma brain natriuretic peptide concentration, left atrial volume index, and mitral deceleration time were associated with these events. Receiver operating characteristic curve analysis revealed that the optimal RV S/D cutoff value to predict events was 1.2 (sensitivity 79%, specificity 65%, area under the curve 0.745). Kaplan-Meier analysis indicated a significantly higher event rate in patients with an RV S/D ratio > 1.2 (log-rank test, P = 0.003). The addition of an RV S/D ratio > 1.2 improved the prognostic utility of a model that included conventional variables (P = 0.014).In patients with advanced heart failure with DCM, the RV S/D ratio was higher in patients with events than in those without events. The addition of the RV S/D ratio to conventional parameters may provide better prognostic information.

Detection of Pulmonary Hypertension with Systolic Pressure Estimated by Doppler Echocardiography

“…Although it is important to attempt a more accurate estimation of systolic PAP by DE, one of the important roles of DE is to screen for suspected PH. 22) The mean PAP reflects the steady component of pulmonary flow and the functional status of the pulmonary vascular resistance, whereas the systolic PAP is expected to encompass the pulsatile component of arterial load, including the characteristics of right ventricular ejection and the characteristics of the proximal elastic pulmonary arteries and wave reflections. 2,3,23) Several studies 24,25) suggested that changes in elasticity and pulsatile pressure are primarily due to an increase in mean PAP in PH.…”

Efficacy of Cognitive Behavioral Therapy for Heart Failure

“…[1][2][3] Heart failure is mainly caused by hypertension, coronary heart disease, valvular heart disease, dilated cardiomyopathy, etc. [4][5][6][7][8] The development of depression is caused by negative thoughts, rumination, feelings of hopelessness about loss of health and independence, as well as an uncertain future. [9][10][11] These depressive symptoms can result in high morbidity and mortality and diminished self-care and health-related quality of life, and there is lack of effective treatment strategies to alleviate depressive symptoms for heart failure.…”

Study of the Correlation Between the Ratio of Diastolic to Systolic Durations and Echocardiography Measurements and Its Application to the Classification of Heart Failure Phenotypes

“…Our findings are consistent with previous studies and offer a plausible explanation for the physiological mechanism that causes a prolonged systolic duration and shortened diastolic duration due to the degree of impaired ventricular function and decreased cardiac output. [20][21][22] The D/S could be a particularly effective indicator because it may monitor 5498 not only prolongation of isovolumic contraction and relaxation periods but also shortening of the diastole filling period. Although durations of systole and especially diastole are strongly affected by heart rate, the correlation between D/S and heart rate in the patients with CHF, and the result shows no significant correlation.…”