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CLINICAL STUDY

Doppler-derived dP/dt and –dP/dt predict survival in congestive heart failure

^a Division of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA

Manuscript received January 14, 2000; revised manuscript received April 25, 2000, accepted June 26, 2000.

Reprint requests and correspondence: Dr. Theodore J. Kolias, Division of Cardiology, University of Michigan Medical Center, L3119 Women’s, 1500 E Medical Center Dr, Ann Arbor, Michigan 48109-0273
tkolias{at}umich.edu

OBJECTIVES

The purpose of this study was to evaluate the ability of novel Doppler indices of left ventricular (LV) systolic and diastolic function to predict survival in patients with congestive heart failure (CHF).

BACKGROUND

Congestive heart failure is associated with an increased risk of death or cardiac transplantation, yet techniques to predict survival are limited.

METHODS

Doppler-derived dP/dt and –dP/dt were determined prospectively from the continuous-wave Doppler spectrum of the mitral regurgitation jet (dP/dt = 32/time between 1 and 3 m/s; –dP/dt = 32/time between 3 and 1 m/s) in 56 patients with chronic CHF (age, 60 ± 15 years; LV ejection fraction, 23 ± 9%). Baseline clinical and echocardiographic variables were also obtained, and clinical follow-up was performed in all patients.

RESULTS

Twenty-four patients experienced a primary event of cardiac death (n = 15), United Network for Organ Sharing status I (inotrope-dependent) heart transplant (n = 3) or urgent implantation of a LV assist device (n = 6). Doppler-derived dP/dt (dichotomized to or <600 mm Hg/s; p = 0.0002) and –dP/dt (trichotomized to <450, 450 to 550 and >550 mm Hg/s; p = 0.0001) predicted event-free survival, as did Doppler-derived risk groups determined by the combination of the two (low risk, dP/dt 600; intermediate risk, dP/dt < 600 and –dP/dt 450; high risk, dP/dt < 600 and –dP/dt < 450; p = 0.0001). Multivariable analysis revealed Doppler-derived risk groups, intravenous inotrope requirement and blood urea nitrogen as significant independent predictors of outcome.

CONCLUSION

New Doppler indices of dP/dt, –dP/dt and risk groups defined by the combination of dP/dt and –dP/dt predict event-free survival in patients with CHF.

Abbreviations and Acronyms   CHF = congestive heart failure   LV = left ventricular   LVEF = left ventricular ejection fraction   MR = mitral regurgitation   UNOS = United Network for Organ Sharing

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