Prognostic value of a tissue doppler index of systodiastolic function in patients with asymptomatic heart failure

Abstract

Introduction:Doppler echocardiography with early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (E') ratio has been proposed as the best predictor for evaluating left ventricle (LV) filling pressure. A dimensionless index E/(E' × S') ratio (S' = systolic mitral annulus velocity) resulted in readily, reproducible, and reliable predictor of LV filling pressure. We assessed the prognostic impact of E/E' × S') in patients with asymptomatic heart failure (HF).Materials and Methods:We calculated E/(E' × S') in 337 patients (179 male, 53%; age 54.7 ± 13.7 years) using the average of septal and lateral mitral annular velocities. We considered a composite endpoint as follows: all-cause death, acute myocardial infarction, stroke, and HF exacerbation.Results:Baseline ejection fraction resulted 60.2 ± 11.8%; E/E' × S') was 1.45 ± 0.8, with S' 7.4 ± 2.4 cm/s and E/E' 9.5 ± 5.4. After a 22-month median follow-up, there were 42 events: 5 deaths (12%), 3 acute myocardial infarctions (7%), 1 stroke (2%), and 33 HF hospitalizations (79%). In patients reaching the composite endpoint, E/(E' × S') resulted 2.07 ± 1.1 versus 1.3 ± 0.7 in event-free population (P < 0.001). In a Cox-regression analysis, adjusted for confounding clinical factors and conventional echo parameters, E/(E' × S') (P < 0.001), age (P < 0.001), and male gender (P = 0.03) resulted independent predictors of the composite endpoint.Conclusions:E/(E' × S') was an independent predictor for the future cardiac events in asymptomatic HF.

Epidemiology of Asymptomatic Pre-heart Failure: a Systematic Review

“…From the 12 retained publications, there were 10 studies reporting prevalence [ 31 ••, 32 ••, 33 ••, 34 ••, 35 ••, 36 ••, 37 ••, 38 ••, 39 ••, 40 ••] with one of these also reporting disease progression and mortality [ 38 ••]. The two remaining studies were reporting disease progression and mortality only [ 41 ••, 42 ••]. Study designs consisted mainly of prospective cohort studies ( n = 5; 41.7%), cross-sectional studies ( n = 4; 33.3%), and retrospective cohort studies ( n = 3; 25.0%).…”

The Incremental Prognostic Value of E/(e’×s’) Ratio in Non-ST-Segment Elevated Acute Coronary Syndrome

“…The energy generated during systole is stored in myocardial collagen fibers, and following relaxation, the ventricle uncoils, creating LV suction. There seems to be a relation of proportionality between decline in contractile function and reduction in recoil, with parallel changes in the extracellular matrix [26,27].…”

Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure

“…However, ARIC longitudinal strain criteria did not identify additional participants who developed symptomatic HF, in comparison with ARIC Stage B HF criteria, in the 1401 SCREEN‐HF participants with global longitudinal strain measurement 5 . Alternative criteria for LV remodelling that predict composite endpoints have been described, but the risk factors for these alternative criteria remain to be identified 21–23 …”

“… 5 Alternative criteria for LV remodelling that predict composite endpoints have been described, but the risk factors for these alternative criteria remain to be identified. 21 , 22 , 23 …”