Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure
GY Xie,
MR Berk,
MD Smith,
JC Gurley,
and
AN DeMaria
Division of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington 40536-0084.
OBJECTIVES. This study was designed to determine whether Doppler echocardiographic transmitral flow patterns can predict cardiac mortality in patients with congestive heart failure. BACKGROUND. Previous studies have indicated that Doppler transmitral flow patterns are related to New York Heart Association functional class and exercise capacity in patients with congestive heart failure. However, the prognostic significance of these flow patterns is not known. METHODS. We analyzed the relation of transmitral flow patterns and cardiac mortality in 100 consecutive patients (76 men, 24 women; mean [+/- SD] age 60 +/- 11 years) with congestive heart failure symptoms and left ventricular ejection fraction < 40%. At the time of entry into the study, functional class and ejection fraction by radionuclide angiography were determined, and Doppler echocardiography was performed in all patients. Transmitral flow was obtained from the apical four-chamber view at the mitral annulus level. Measurements included early (E) and atrial (A) filling velocities, E/A ratio and deceleration time of the E wave. The patients were assigned to two groups according to E/A ratio or deceleration time of transmitral flow patterns, or both: a non-restrictive group (42 patients) with E/A < or = 1 or E/A = 1 to 2 and deceleration time > 140 ms, and a restrictive group (58 patients) with E/A > or = 2 or E/A = 1 to 2 and deceleration time < or = 140 ms. RESULTS. Of 100 patients, 26 died during a mean follow-up period of 16 +/- 8 months. The cumulative cardiac mortality rate determined by the Kaplan-Meier method was 14% at 1 year and 35% at 2 years. Cox proportional hazards model analysis revealed that transmitral flow (restrictive vs. nonrestrictive, chi-square 6.99, p = 0.008), patient gender (female vs. male, chi-square 4.59, p = 0.03) and New York Heart Association functional class (IV vs. II, chi-square 3.95, p = 0.05) were significantly related to cardiac mortality in patients with congestive heart failure. Mortality rate in the restrictive group was markedly higher than that in the nonrestrictive group at 1 year (19% vs. 5%, respectively, p < 0.05) and at 2 years (51% vs. 5%, respectively, p < 0.01) by log-rank test. Relative risk for cardiac death was estimated as 4.1 at 1 year and 8.6 at 2 years in the restrictive group compared with the nonrestrictive group. CONCLUSIONS. In patients with congestive heart failure, a restrictive transmitral flow pattern, female gender and advanced functional class are predictive of higher cardiac mortality. The restrictive transmitral flow pattern by Doppler echocardiography is the single best clinical predictor for cardiac death in patients with congestive heart failure.
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Natriuretic peptides in patients with diastolic dysfunction due to idiopathic dilated cardiomyopathy
Eur. Heart J.,
October 1, 1999;
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[Abstract]
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M. Pepi, P. Agostoni, G. Marenzi, E. Doria, M. Guazzi, G. Lauri, A. Maltagliati, and M. Guazzi
The influence of diastolic and systolic function on exercise performance in heart failure due to dilated cardiomyopathy or ischemic heart disease
Eur J Heart Fail,
June 1, 1999;
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[Abstract]
[Full Text]
[PDF]
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R. Willenheimer, B. Israelsson, C. Cline, E. Rydberg, K. Broms, and L. Erhardt
Left atrioventricular plane displacement is related to both systolic and diastolic left ventricular performance in patients with chronic heart failure
Eur. Heart J.,
April 2, 1999;
20(8):
612 - 618.
[Abstract]
[PDF]
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F A Bu'Lock, M Sood, J V De Giovanni, and S H Green
Left ventricular diastolic function in congenital myotonic dystrophy
Arch. Dis. Child.,
March 1, 1999;
80(3):
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[Abstract]
[Full Text]
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L. B. Rosario, L. W. Stevenson, S. D. Solomon, R. T. Lee, and S. C. Reimold
The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size
J. Am. Coll. Cardiol.,
December 1, 1998;
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[Abstract]
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P. de Groote, A. Millaire, C. Foucher-Hossein, O. Nugue, X. Marchandise, G.e. Ducloux, and J.-M. Lablanche
Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure
J. Am. Coll. Cardiol.,
October 1, 1998;
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948 - 954.
[Abstract]
[Full Text]
[PDF]
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T. Shimada, M. Yoshiyama, K. Takeuchi, T. Omura, Y. Takemoto, S. Kim, H. Iwao, and J. Yoshikawa
Long acting calcium antagonist amlodipine prevents left ventricular remodeling after myocardial infarction in rats
Cardiovasc Res,
March 1, 1998;
37(3):
618 - 626.
[Abstract]
[Full Text]
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K. T. Weber
Extracellular Matrix Remodeling in Heart Failure : A Role for De Novo Angiotensin II Generation
Circulation,
December 2, 1997;
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4065 - 4082.
[Full Text]
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G. D. Pennock, D. D. Yun, P. G. Agarwal, P. H. Spooner, and S. Goldman
Echocardiographic changes after myocardial infarction in a model of left ventricular diastolic dysfunction
Am J Physiol Heart Circ Physiol,
October 1, 1997;
273(4):
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[Abstract]
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[PDF]
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M. Pozzoli, E. Traversi, G. Cioffi, R. Stenner, M. Sanarico, and L. Tavazzi
Loading Manipulations Improve the Prognostic Value of Doppler Evaluation of Mitral Flow in Patients With Chronic Heart Failure
Circulation,
March 4, 1997;
95(5):
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[Abstract]
[Full Text]
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S. F. Nagueh, H. A. Kopelen, and M. A. Quinones
Assessment of Left Ventricular Filling Pressures by Doppler in the Presence of Atrial Fibrillation
Circulation,
November 1, 1996;
94(9):
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[Abstract]
[Full Text]
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B. Andersson, K. Caidahl, A. di Lenarda, S. E. Warren, F. Goss, A. Waldenstrom, S. Persson, I. Wallentin, A. Hjalmarson, and F. Waagstein
Changes in Early and Late Diastolic Filling Patterns Induced by Long-term Adrenergic ß-Blockade in Patients With Idiopathic Dilated Cardiomyopathy
Circulation,
August 15, 1996;
94(4):
673 - 682.
[Abstract]
[Full Text]
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C.M. Yu, J.E. Sanderson, S. Chan, L. Yeung, Y.T. Hung, and K.S. Woo
Right Ventricular Diastolic Dysfunction in Heart Failure
Circulation,
April 15, 1996;
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[Abstract]
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C.-M. Yu, H. Lin, H. Yang, S.-L. Kong, Q. Zhang, and S. W.-L. Lee
Progression of Systolic Abnormalities in Patients With "Isolated" Diastolic Heart Failure and Diastolic Dysfunction
Circulation,
March 12, 2002;
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[Abstract]
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