CLINICAL STUDY: HEART FAILURE
Prognostic value of pulmonary venous flow Doppler signal in left ventricular dysfunction
contribution of the difference in duration of pulmonary venous and mitral flow at atrial contraction
Frank Lloyd Dini, MD*,
Claudio Michelassi ,
Giovanni Micheli, MD* and
Daniele Rovai, MD, FESC
* Unità Operativa di Cardiologia, Villamarina Hospital, Piombino, Italy
CNR, Clinical Physiology Institute, Pisa, Italy
Manuscript received May 4, 1999;
revised manuscript received March 16, 2000,
accepted April 28, 2000.
Reprint requests and correspondence: Dr. Daniele Rovai, CNR Clinical Physiology Institute, Via Savi, 8, 56126—Pisa, Italy
drovai{at}ifc.pi.cnr.it
OBJECTIVES
We assessed the contribution of difference in duration of pulmonary venous and mitral flow at atrial contraction (ARd-Ad) for prognostic stratification of patients with left ventricular (LV) systolic dysfunction.
BACKGROUND
Although pulmonary venous flow (PVF) variables may supplement mitral flow patterns in evaluating left ventricular (LV) diastolic function, their value to the prognostic stratification of patients has not been investigated.
METHODS
Pulsed wave Doppler mitral and PVF velocity curves were recorded in 145 patients (mean age: 70 years) with LV systolic dysfunction secondary to ischemic or nonischemic cardiomyopathy who were followed for 15 ± 8 months. In 38% of patients, PVF signal was enhanced by the intravenous (IV) administration of a galactose-based echo-contrast agent. Based on E-wave deceleration time  or >130 ms and ARd-Ad, patients were grouped into restrictive (group 1, n = 40), nonrestrictive with ARd-Ad  30 ms (group 2, n = 55) and nonrestrictive with ARd-Ad <30 ms (group 3, n = 50).
RESULTS
During follow-up, 29 patients died from cardiac causes and 28 were hospitalized for worsening heart failure (HF). On multivariate Cox model, ARd-Ad 30 ms provided important prognostic information with regard to cardiac mortality and emerged as the single best predictor of cardiac events (cardiac mortality, hospitalization). The 24-month cardiac event-free survival was best (86.3%) for group 3; it was intermediate (37.9%) for group 2; and it was worst (22.9%) for group 1 (p < 0.0002 group 1 vs. 3; p < 0.0005 group 2 vs. 3; p < 0.0003 group 1 vs. group 2).
CONCLUSIONS
Assessment of ARd-Ad exhibited an independent value in the prognostic evaluation of patients with LV systolic dysfunction. Moreover, it contributed to identify patients at low, intermediate and high risk of cardiac events.
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Abbreviations and Acronyms
| | ARd-Ad | = difference in duration of pulmonary venous and mitral flow at atrial contraction | | E/A | = early-to-atrial wave ratio | | EDT | = early wave deceleration time | | EF | = ejection fraction | | HF | = heart failure | | HR | = heart rate | | LV | = left ventricular | | NYHA | = New York Heart Association | | PVF | = pulmonary venous flow |
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