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 Whalley, G. A. Articles by Sharpe, N. Search for Related Content PubMed PubMed Citation Articles by Whalley, G. A. Articles by Sharpe, N.

CLINICAL STUDY

Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure

^* Division of Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

Manuscript received October 29, 2001; revised manuscript received January 28, 2002, accepted March 13, 2002.

^* Reprint requests and correspondence: Ms. Gillian Whalley, Division of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92 019, Auckland, New Zealand.
g.whalley{at}auckland.ac.nz

OBJECTIVES: We sought to investigate whether pseudonormal (PN) filling was associated with death or hospital admission in patients with congestive heart failure (CHF).

BACKGROUND: The high mortality rate associated with CHF is related to many clinical and echocardiographic variables. In particular, a short mitral deceleration time and restrictive diastolic filling predict death and/or hospital admission. We hypothesized that differentiating patients with nonrestrictive filling might identify an intermediate PN group that may be associated with intermediate risk.

METHODS: A total of 115 patients admitted to the hospital for exacerbation of CHF symptoms underwent pre-discharge Doppler echocardiography to determine mitral inflow (before and after preload reduction) and pulmonary venous return. Patients were followed up for one year, and all-cause mortality and re-admission data were analyzed.

RESULTS: The classification of filling patterns was: abnormal relaxation (AR) in 46 (40%) patients, pseudonormal (PN) filling in 42 (36.5%) patients and restrictive filling pattern (RFP) in 27 (23.4%) patients. When comparing the RFP group with the AR group, all-cause mortality was higher (38.4% vs. 17.4%, p = 0.033), hospital admission was higher (70.3% vs. 54.3%, p = 0.073), death/hospital admission was higher (77.8% vs. 56.5%, p = 0.02), CHF hospital admission was higher (40.7% vs. 15.2%, p = 0.01) and death/CHF hospital admission was higher (62.9% vs. 26.1%, p = 0.0005). Mortality in the PN group was not significantly different from that in the two other groups, but re-admissions were higher than the AR group (76.2% vs. 54.3%, p = 0.006), as was death/re-admission (78.6% vs. 56.5%, p = 0.004) and death/CHF re-admission (47.6% vs. 26.1%, p = 0.03). Re-admissions in the PN and RFP groups were comparable.

CONCLUSIONS: In a general hospital population of older patients with CHF, PN filling was associated with hospital admission rates similar to those seen with restrictive filling. The combined end point of death/CHF hospital admission was similar for restrictive filling and AR. Measurement of these variables is easy to add to routine clinical echocardiography and may provide important prognostic information in a wide range of patients with CHF.

Abbreviations and Acronyms   AR   abnormal relaxation   CHF   congestive heart failure   DT   deceleration time   E/A   ratio early to late filling ratio   ECG   electrocardiogram   EF   ejection fraction   LA   left atrium   LV   left ventricle   NYHA   New York Heart Association   PN   pseudonormal   PWD   pulsed wave Doppler   RFP   restrictive filling pattern

This article has been cited by other articles:

				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]

				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]

				G. A. Whalley, S. P. Wright, A. Pearl, G. D. Gamble, H. J. Walsh, M. Richards, and R. N. Doughty Prognostic role of echocardiography and brain natriuretic peptide in symptomatic breathless patients in the community Eur. Heart J., February 2, 2008; 29(4): 509 - 516. [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]

				M. M. Barbosa, M. d. C. P. Nunes, A. L. P. Ribeiro, M. M. Barral, and M. O. C. Rocha N-terminal proBNP levels in patients with Chagas disease: A marker of systolic and diastolic dysfunction of the left ventricle Eur J Echocardiogr, June 1, 2007; 8(3): 204 - 212. [Abstract] [Full Text] [PDF]

				P. K. Stein, L. Tereshchenko, P. P. Domitrovich, R. E. Kleiger, A. Perez, and P. Deedwania Diastolic dysfunction and autonomic abnormalities in patients with systolic heart failure Eur J Heart Fail, April 1, 2007; 9(4): 364 - 369. [Abstract] [Full Text] [PDF]

				J. E. Moller, P. A. Pellikka, G. S. Hillis, and J. K. Oh Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction Circulation, August 1, 2006; 114(5): 438 - 444. [Full Text] [PDF]

				M. J Wood and M. H Picard Utility of echocardiography in the evaluation of individuals with cardiomyopathy Heart, June 1, 2004; 90(6): 707 - 712. [Full Text] [PDF]

				D. Logeart, G. Thabut, P. Jourdain, C. Chavelas, P. Beyne, F. Beauvais, E. Bouvier, and A. C. Solal Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure J. Am. Coll. Cardiol., February 18, 2004; 43(4): 635 - 641. [Abstract] [Full Text] [PDF]

				G. S. Pressman Hemodynamic profiles in heart failure patients J. Am. Coll. Cardiol., January 7, 2004; 43(1): 151 - 151. [Full Text] [PDF]

				A. Nohria, S. W. Tsang, J. C. Fang, E. F. Lewis, J. A. Jarcho, G. H. Mudge, and L. W. Stevenson Hemodynamic profiles in heart failure: Reply J. Am. Coll. Cardiol., January 7, 2004; 43(1): 151 - 151. [Full Text] [PDF]

				G.-Y. Xie and M. D. Smith Pseudonormal or intermediate pattern? J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1796 - 1798. [Full Text] [PDF]