This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hansen, A. Articles by Kuecherer, H. Search for Related Content PubMed PubMed Citation Articles by Hansen, A. Articles by Kuecherer, H.

CLINICAL STUDY: HEART FAILURE

Prognostic value of Doppler echocardiographic mitral inflow patterns: implications for risk stratification in patients with chronic congestive heart failure

Alexander Hansen, MD^*, Markus Haass, MD^*, Christian Zugck, MD^*, Carsten Krueger, MD^*, Kristina Unnebrink, PhD, Rainer Zimmermann, MD^*, Wolfgang Kuebler, MD, FACC^* and Helmut Kuecherer, MD^*

^* Department of Cardiology, University of Heidelberg, Heidelberg, Germany
Medical Biometry, University of Heidelberg, Heidelberg, Germany

Manuscript received August 2, 2000; revised manuscript received November 3, 2000, accepted December 1, 2000.

Reprint requests and correspondence: Dr. Helmut Kuecherer, Department of Cardiology, University of Heidelberg, Bergheimerstrasse 58, D-69115 Heidelberg, Germany
Helmut_Kuecherer{at}med.uni-heidelberg.de

OBJECTIVES

This prospective study tested whether transmitral flow patterns add incremental value to peak oxygen consumption (;-4uO₂) in determining the prognosis of patients with chronic congestive heart failure (CHF) and systolic dysfunction.

BACKGROUND

Peak ;-4uO₂ is an objective marker of functional capacity and is routinely used as a criterion to identify heart transplant candidates. Diastolic dysfunction limits functional capacity, but its prognostic importance relative to that of peak ;-4uO₂ is unknown.

METHODS

Peak ;-4uO₂ and mitral inflow velocities were prospectively measured in 311 consecutive patients (mean age 54 years, 84% male) with impaired left ventricular function (ejection fraction <40%; 88 patients with ischemic and 223 with dilated cardiomyopathy) who were evaluated for heart transplant candidacy.

RESULTS

During a mean follow-up period of 512 ± 314 days, 65 patients died and 43 patients underwent heart transplantation. Diastolic filling patterns, peak ;-4uO₂ and left ventricular end-diastolic diameters were independent predictors of cardiac mortality. In patients with peak ;-4uO₂ 14 ml/min per kg body weight, the outcome was markedly poorer in the presence of restrictive filling patterns as compared with their absence (two-year survival rate 52% vs. 80%). Similarly, despite peak ;-4uO₂ levels >14 ml/min per kg, the outcome was less favorable in the presence of restrictive filling patterns (two-year survival rate 80% vs. 94%). A risk-stratification model based on the identified independent noninvasive predictors separated groups into those with high (93%), intermediate (65%) and low (39%) two-year survival rates.

CONCLUSIONS

Transmitral flow patterns add incremental value to peak ;-4uO₂ in determining the prognosis of patients with CHF and impaired systolic function.

Abbreviations and Acronyms   A = late diastolic filling velocity   CHF = congestive heart failure   DT = deceleration time   E = early diastolic filling velocity   ECG = electrocardiogram   LVEDD = left ventricular end-diastolic diameter   LVEF = left ventricular ejection fraction   OR = odds ratio   ;-4uO2 = oxygen consumption

This article has been cited by other articles:

				W.-H. Ding, Y.-Y. Lam, A. Duncan, W. Li, E. Lim, M. G. Kaya, R. Chung, J. R. Pepper, and M. Y. Henein Predictors of survival after aortic valve replacement in patients with low-flow and high-gradient aortic stenosis Eur J Heart Fail, July 11, 2009; (2009) hfp096v1. [Abstract] [Full Text] [PDF]

				E. Carluccio, P. Biagioli, G. Alunni, A. Murrone, V. Leonelli, P. Pantano, G. Vincenti, C. Giombolini, T. Ragni, G. Reboldi, et al. Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic cardiomyopathy Eur. Heart J., June 2, 2009; 30(12): 1501 - 1509. [Abstract] [Full Text] [PDF]

				S. F. Nagueh, C. P. Appleton, T. C. Gillebert, P. N. Marino, J. K. Oh, O. A. Smiseth, A. D. Waggoner, F. A. Flachskampf, P. A. Pellikka, and A. Evangelisa Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography Eur J Echocardiogr, March 1, 2009; 10(2): 165 - 193. [Full Text] [PDF]

				G. Bajraktari, A. Duncan, J. Pepper, and M. Henein Prolonged total isovolumic time predicts cardiac events following coronary artery bypass surgery Eur J Echocardiogr, November 1, 2008; 9(6): 779 - 783. [Abstract] [Full Text] [PDF]

				Meta-analysis Research Group in Echocardiography ( Independence of restrictive filling pattern and LV ejection fraction with mortality in heart failure: An individual patient meta-analysis Eur J Heart Fail, August 1, 2008; 10(8): 786 - 792. [Abstract] [Full Text] [PDF]

				M. K. Friedberg, S. L. Roche, A. F. Mohammed, M. Balasingam, E. G. Atenafu, and P. F. Kantor Left Ventricular Diastolic Mechanical Dyssynchrony and Associated Clinical Outcomes in Children With Dilated Cardiomyopathy Circ Cardiovasc Imaging, July 1, 2008; 1(1): 50 - 57. [Abstract] [Full Text] [PDF]

				D. Akkan, J. Kjaergaard, J. E. Moller, C. Hassager, C. Torp-Pedersen, L. Kober, and EchoCardiography and Heart Outcome Study (ECHOS) i Prognostic importance of a short deceleration time in symptomatic congestive heart failure Eur J Heart Fail, July 1, 2008; 10(7): 689 - 695. [Abstract] [Full Text] [PDF]

				P de Groote, V Gressin, E Hachulla, P Carpentier, L Guillevin, A Kahan, J Cabane, C Frances, N Lamblin, E Diot, et al. Evaluation of cardiac abnormalities by Doppler echocardiography in a large nationwide multicentric cohort of patients with systemic sclerosis Ann Rheum Dis, January 1, 2008; 67(1): 31 - 36. [Abstract] [Full Text] [PDF]

				A. Rossi, M. Cicoira, S. Bonapace, G. Golia, L. Zanolla, L. Franceschini, and C. Vassanelli Left atrial volume provides independent and incremental information compared with exercise tolerance parameters in patients with heart failure and left ventricular systolic dysfunction Heart, November 1, 2007; 93(11): 1420 - 1425. [Abstract] [Full Text] [PDF]

				J. N. Kirkpatrick, M. A. Vannan, J. Narula, and R. M. Lang Echocardiography in Heart Failure: Applications, Utility, and New Horizons J. Am. Coll. Cardiol., July 31, 2007; 50(5): 381 - 396. [Abstract] [Full Text] [PDF]

				G A Whalley, G D Gamble, and R N Doughty Restrictive diastolic filling predicts death after acute myocardial infarction: systematic review and meta-analysis of prospective studies Heart, November 1, 2006; 92(11): 1588 - 1594. [Abstract] [Full Text] [PDF]

				H. Izawa, T. Murohara, K. Nagata, S. Isobe, H. Asano, T. Amano, S. Ichihara, T. Kato, S. Ohshima, Y. Murase, et al. Mineralocorticoid Receptor Antagonism Ameliorates Left Ventricular Diastolic Dysfunction and Myocardial Fibrosis in Mildly Symptomatic Patients With Idiopathic Dilated Cardiomyopathy: A Pilot Study Circulation, November 8, 2005; 112(19): 2940 - 2945. [Abstract] [Full Text] [PDF]

				A. Rovner, N. L. Greenberg, J. D. Thomas, and M. J. Garcia Relationship of diastolic intraventricular pressure gradients and aerobic capacity in patients with diastolic heart failure Am J Physiol Heart Circ Physiol, November 1, 2005; 289(5): H2081 - H2088. [Abstract] [Full Text] [PDF]

				A. M. Duncan, E. Lim, D. G. Gibson, and M. Y. Henein Effect of Dobutamine Stress on Left Ventricular Filling in Ischemic Dilated Cardiomyopathy: Pathophysiology and Prognostic Implications J. Am. Coll. Cardiol., August 2, 2005; 46(3): 488 - 496. [Abstract] [Full Text] [PDF]

				C. Bruch, M. Gotzmann, J. Stypmann, F. Wenzelburger, M. Rothenburger, M. Grude, H. H. Scheld, L. Eckardt, G. Breithardt, and T. Wichter Electrocardiography and Doppler echocardiography for risk stratification in patients with chronic heart failure: Incremental prognostic value of QRS duration and a restrictive mitral filling pattern J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1072 - 1075. [Abstract] [Full Text] [PDF]

				C J McMahon, S F Nagueh, R S Eapen, W J Dreyer, I Finkelshtyn, X Cao, B W Eidem, L I Bezold, S W Denfield, J A Towbin, et al. Echocardiographic predictors of adverse clinical events in children with dilated cardiomyopathy: a prospective clinical study Heart, August 1, 2004; 90(8): 908 - 915. [Abstract] [Full Text] [PDF]

				G. Schillaci, L. Pasqualini, P. Verdecchia, G. Vaudo, S. Marchesi, C. Porcellati, G. de Simone, and E. Mannarino Prognostic significance of left ventricular diastolic dysfunction in essential hypertension J. Am. Coll. Cardiol., June 19, 2002; 39(12): 2005 - 2011. [Abstract] [Full Text] [PDF]

				G. A. Whalley, R. N. Doughty, G. D. Gamble, S. P. Wright, H. J. Walsh, S. A. Muncaster, and N. Sharpe Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1787 - 1795. [Abstract] [Full Text] [PDF]

				C. Zugck, A. Haunstetter, C. Kruger, R. Kell, D. Schellberg, W. Kubler, and M. Haass Impact of beta-blocker treatment on the prognostic value of currently used risk predictors in congestive heart failure J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1615 - 1622. [Abstract] [Full Text] [PDF]