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A new tissue Doppler index to predict cardiac death in patients with heart failure.

Mornos C, Petrescu L, Cozma D, Ionac A - Arq. Bras. Cardiol. (2013)

Bottom Line: Worsening of E/(E'×S') was defined as any increase of baseline value.At discharge, 252 patients (74.3%) presented E/(E'×S') ≤ 2.83 (group I) and 87 (25.7%) presented E/(E'×S') > 2.83 (group II), respectively.Patients with E/(E'×S') > 2.83 at discharge and its worsening after one month presented the worst prognosis (all p < 0.05).

View Article: PubMed Central - PubMed

Affiliation: "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.

ABSTRACT

Background: It has been shown that a new tissue Doppler index, E/(E'×S'), including the ratio between early diastolic transmitral and mitral annular velocity (E/E'), and the systolic mitral annular velocity (S'), has a good accuracy to predict left ventricular filling pressure.

Objectives: We investigated the value of E/(E'×S') to predict cardiac death in patients with heart failure.

Methods: Echocardiography was performed in 339 consecutive hospitalized patients with heart failure, in sinus rhythm, after appropriate medical treatment, at discharge and after one month. Worsening of E/(E'×S') was defined as any increase of baseline value. The end point was cardiac death.

Results: During the follow-up period (35.2 ± 8.8 months), cardiac death occurred in 51 patients (15%). The optimal cut-off value for the initial E/(E'×S') to predict cardiac death was 2.83 (76% sensitivity, 85% specificity). At discharge, 252 patients (74.3%) presented E/(E'×S') ≤ 2.83 (group I) and 87 (25.7%) presented E/(E'×S') > 2.83 (group II), respectively. Cardiac death was significantly higher in group II than in group I (38 deaths, 43.7% vs 13 deaths, 5.15%, p < 0.001). By multivariate Cox regression analysis, including variables that affected outcome in univariate analysis, E/(E'×S') at discharge was the best independent predictor of cardiac death (hazard ratio = 3.09, 95% confidence interval = 1.81-5.31, p = 0.001). Patients with E/(E'×S') > 2.83 at discharge and its worsening after one month presented the worst prognosis (all p < 0.05).

Conclusions: In patients with heart failure, the E/(E'×S') ratio is a powerful predictor of cardiac death, particularly if it is associated with its worsening.

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Related in: MedlinePlus

Kaplan-Meier survival curves of patients classified according to the initialE/(E’×S’) value and to E/(E’×S’) worsening one month after hospital discharge:a) in patients with left ventricular ejection fraction ≥50%, thepercentage of survival was 95.7% in those with initial E/(E’×S’) ≤2.83 and noworsening, 96.3% in patients with E/(E’×S’) ≤2.83 and worsening after one month,62.5% in patients with E/(E’×S’) >2.83 and no worsening, and 25% in those withinitial E/(E’×S’) >2.83 and worsening at one month, respectively;b) in patients with left ventricular ejection fraction <50% thepercentage of survival was 95.7% in those with initial E/(E’×S’) ≤2.83 and noworsening, 85.7% in patients with E/(E’×S’) ≤2.83 and worsening after one month,66.7% in patients with E/(E’×S’) >2.83 and no worsening, and 45.5% in thosewith initial E/(E’×S’) >2.83 and worsening at one month, respectively. E:maximal early diastolic transmitral velocity; E’: maximal early mitral annulardiastolic velocity using the average of the medial and lateral site of mitralannulus; S’: maximal systolic mitral annular velocity using the average of themedial and lateral site of mitral annulus.
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f05: Kaplan-Meier survival curves of patients classified according to the initialE/(E’×S’) value and to E/(E’×S’) worsening one month after hospital discharge:a) in patients with left ventricular ejection fraction ≥50%, thepercentage of survival was 95.7% in those with initial E/(E’×S’) ≤2.83 and noworsening, 96.3% in patients with E/(E’×S’) ≤2.83 and worsening after one month,62.5% in patients with E/(E’×S’) >2.83 and no worsening, and 25% in those withinitial E/(E’×S’) >2.83 and worsening at one month, respectively;b) in patients with left ventricular ejection fraction <50% thepercentage of survival was 95.7% in those with initial E/(E’×S’) ≤2.83 and noworsening, 85.7% in patients with E/(E’×S’) ≤2.83 and worsening after one month,66.7% in patients with E/(E’×S’) >2.83 and no worsening, and 45.5% in thosewith initial E/(E’×S’) >2.83 and worsening at one month, respectively. E:maximal early diastolic transmitral velocity; E’: maximal early mitral annulardiastolic velocity using the average of the medial and lateral site of mitralannulus; S’: maximal systolic mitral annular velocity using the average of themedial and lateral site of mitral annulus.

Mentions: One month after hospital discharge we identified worsening of E/(E'×S') ratio in 97patients (28.6%). Of these patients, 37 (10.9%) presented the initial value of E/(E'×S')greater than 2.83. However, as shown in Figure 4,E/(E'×S') worsening was associated with lower survival rate, regardless of the E/(E'×S')value at inclusion in the study (43.2% versus 66%, p = 0.021 in patients with theinitial E/(E'×S') > 2.83, and 90.3% vs. 96.3%, p = 0.046 in those with E/(E'×S') ≤2.83 at hospital discharge, respectively). The subgroup of patients with an initialE/(E'×S') ratio > 2.83 and its worsening after one month presented the worstprognosis in the overall population, and in those with preserved or reduced LVEF (Figures 4 and 5). This analysis was underpowered (< 80%) because of small sample size,small difference in median survival, and subgroup comparisons.


A new tissue Doppler index to predict cardiac death in patients with heart failure.

Mornos C, Petrescu L, Cozma D, Ionac A - Arq. Bras. Cardiol. (2013)

Kaplan-Meier survival curves of patients classified according to the initialE/(E’×S’) value and to E/(E’×S’) worsening one month after hospital discharge:a) in patients with left ventricular ejection fraction ≥50%, thepercentage of survival was 95.7% in those with initial E/(E’×S’) ≤2.83 and noworsening, 96.3% in patients with E/(E’×S’) ≤2.83 and worsening after one month,62.5% in patients with E/(E’×S’) >2.83 and no worsening, and 25% in those withinitial E/(E’×S’) >2.83 and worsening at one month, respectively;b) in patients with left ventricular ejection fraction <50% thepercentage of survival was 95.7% in those with initial E/(E’×S’) ≤2.83 and noworsening, 85.7% in patients with E/(E’×S’) ≤2.83 and worsening after one month,66.7% in patients with E/(E’×S’) >2.83 and no worsening, and 45.5% in thosewith initial E/(E’×S’) >2.83 and worsening at one month, respectively. E:maximal early diastolic transmitral velocity; E’: maximal early mitral annulardiastolic velocity using the average of the medial and lateral site of mitralannulus; S’: maximal systolic mitral annular velocity using the average of themedial and lateral site of mitral annulus.
© Copyright Policy - open-access
Related In: Results  -  Collection

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f05: Kaplan-Meier survival curves of patients classified according to the initialE/(E’×S’) value and to E/(E’×S’) worsening one month after hospital discharge:a) in patients with left ventricular ejection fraction ≥50%, thepercentage of survival was 95.7% in those with initial E/(E’×S’) ≤2.83 and noworsening, 96.3% in patients with E/(E’×S’) ≤2.83 and worsening after one month,62.5% in patients with E/(E’×S’) >2.83 and no worsening, and 25% in those withinitial E/(E’×S’) >2.83 and worsening at one month, respectively;b) in patients with left ventricular ejection fraction <50% thepercentage of survival was 95.7% in those with initial E/(E’×S’) ≤2.83 and noworsening, 85.7% in patients with E/(E’×S’) ≤2.83 and worsening after one month,66.7% in patients with E/(E’×S’) >2.83 and no worsening, and 45.5% in thosewith initial E/(E’×S’) >2.83 and worsening at one month, respectively. E:maximal early diastolic transmitral velocity; E’: maximal early mitral annulardiastolic velocity using the average of the medial and lateral site of mitralannulus; S’: maximal systolic mitral annular velocity using the average of themedial and lateral site of mitral annulus.
Mentions: One month after hospital discharge we identified worsening of E/(E'×S') ratio in 97patients (28.6%). Of these patients, 37 (10.9%) presented the initial value of E/(E'×S')greater than 2.83. However, as shown in Figure 4,E/(E'×S') worsening was associated with lower survival rate, regardless of the E/(E'×S')value at inclusion in the study (43.2% versus 66%, p = 0.021 in patients with theinitial E/(E'×S') > 2.83, and 90.3% vs. 96.3%, p = 0.046 in those with E/(E'×S') ≤2.83 at hospital discharge, respectively). The subgroup of patients with an initialE/(E'×S') ratio > 2.83 and its worsening after one month presented the worstprognosis in the overall population, and in those with preserved or reduced LVEF (Figures 4 and 5). This analysis was underpowered (< 80%) because of small sample size,small difference in median survival, and subgroup comparisons.

Bottom Line: Worsening of E/(E'×S') was defined as any increase of baseline value.At discharge, 252 patients (74.3%) presented E/(E'×S') ≤ 2.83 (group I) and 87 (25.7%) presented E/(E'×S') > 2.83 (group II), respectively.Patients with E/(E'×S') > 2.83 at discharge and its worsening after one month presented the worst prognosis (all p < 0.05).

View Article: PubMed Central - PubMed

Affiliation: "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.

ABSTRACT

Background: It has been shown that a new tissue Doppler index, E/(E'×S'), including the ratio between early diastolic transmitral and mitral annular velocity (E/E'), and the systolic mitral annular velocity (S'), has a good accuracy to predict left ventricular filling pressure.

Objectives: We investigated the value of E/(E'×S') to predict cardiac death in patients with heart failure.

Methods: Echocardiography was performed in 339 consecutive hospitalized patients with heart failure, in sinus rhythm, after appropriate medical treatment, at discharge and after one month. Worsening of E/(E'×S') was defined as any increase of baseline value. The end point was cardiac death.

Results: During the follow-up period (35.2 ± 8.8 months), cardiac death occurred in 51 patients (15%). The optimal cut-off value for the initial E/(E'×S') to predict cardiac death was 2.83 (76% sensitivity, 85% specificity). At discharge, 252 patients (74.3%) presented E/(E'×S') ≤ 2.83 (group I) and 87 (25.7%) presented E/(E'×S') > 2.83 (group II), respectively. Cardiac death was significantly higher in group II than in group I (38 deaths, 43.7% vs 13 deaths, 5.15%, p < 0.001). By multivariate Cox regression analysis, including variables that affected outcome in univariate analysis, E/(E'×S') at discharge was the best independent predictor of cardiac death (hazard ratio = 3.09, 95% confidence interval = 1.81-5.31, p = 0.001). Patients with E/(E'×S') > 2.83 at discharge and its worsening after one month presented the worst prognosis (all p < 0.05).

Conclusions: In patients with heart failure, the E/(E'×S') ratio is a powerful predictor of cardiac death, particularly if it is associated with its worsening.

Show MeSH
Related in: MedlinePlus