Independence of restrictive filling pattern and LV ejection fraction with mortality in heart failure: An individual patient meta-analysisMeRGE collaboratorsEur J Heart Fail2008108)78679218617438
European Journal of Heart Failure (Impact Factor: 6.53). 08/2008; 10(8):786-792. DOI: 10.1016/j.ejheart.2008.06.005
Background: The Doppler echocardiographic restrictive mitral filling pattern (RFP) is an important prognostic indicator in patients with heart failure (HF), but the interaction between RFP, left ventricular ejection fraction (LVEF) and filling pattern remains uncertain. Aims: To determine whether the RFP is predictive of mortality independently of LVEF in patients with HF. Methods: Online databases were searched to identify studies assessing the relationship between prognosis and LV filling pattern in patients with HE Individual patient data from 18 studies (3540 patients) were extracted and collated at the MeRGE Coordinating Centre (The University of Auckland). Results: Overall, RFP was associated with higher all-cause mortality than the non-restrictive filling pattern: hazard ratio 2,42 (95% CI 2.06, 2.83). In multivariable analysis the RFP, LVEF, NYHA class and age were independent predictors of mortality. The prevalence of the RFP was inversely related to LVEF but remained a predictor of mortality even in those patients with preserved LVEF. Conclusions: The restrictive mitral filling pattern is a powerful predictor of mortality, independent of LVEF and age, in patients with HF Doppler-derived LV filling patterns are an accessible marker front echocardiography that can readily be incorporated in risk stratification of all patients with HF.
- [Show abstract] [Hide abstract]
ABSTRACT: The mechanics of the complex left ventricular (LV) myocardial fiber architecture may accurately be assessed by speckle tracking echocardiography (STE). The role of STE to assess LV mechanical dysfunction in the setting of ST segment elevation myocardial infarction (AMI) is still poorly studied. 29 consecutive patients (55 +/- 13 years) presenting with AMI underwent STE within 72 hours of admission. Reperfusion was achieved with thrombolysis in 15 patients and with primary percutaneous coronary intervention in 14. LV rotational and torsion data were registered during peak systole. Standard Doppler data included LV ejection fraction (EF), mitral inflow deceleration time (DT), and conventional E/A ratio. E/E' ratio (mitral inflow E velocity/tissue Doppler E velocity) was calculated as a marker of LV filling pressure. Twelve subjects with clinically indicated but negative dobutamine stress echocardiogram served as Controls. Peak systolic torsion was not only significantly lower in AMI compared with Controls (13.3 +/- 7.6 vs. 21.8 +/- 6.1; P < 0.01), it was also lower in subjects with LVEF <40% (5.0 +/- 2.9) compared with those who had LVEF >40% (10.6 +/- 6.6; P < 0.02). Torsion had a modest but significantly positive linear relation (R = 0.6; P < 0.05) with DT, not with E/E' or LVEF. LV systolic torsion is decreased in AMI and more markedly decreased in patients with LVEF <40%. The most significant linear relationship between DT and torsion may possibly indicate that the LV mechanical dysfunction is also associated with altered filling dynamics.Echocardiography 09/2009; 27(1):45-9. DOI:10.1111/j.1540-8175.2009.00971.x · 1.25 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: A prolonged total isovolumic time (T-IVT) has been shown to be associated with worsening survival in patients submitted to coronary artery surgery. However, it is not known whether it has prognostic significance in patients with chronic systolic heart failure (HF). To determine the prognostic value of T-IVT in comparison with other clinical, biochemical and echocardiographic variables in patients with chronic systolic HF. Patients (n=107; age 68±12 years, 25% women) with chronic systolic HF, left ventricular ejection fraction (EF)<45%, and sinus rhythm, underwent a complete Doppler echocardiographic study, that included tissue Doppler long axis velocities and total isovolumic time (T-IVT), determined as [60-(total ejection time+total filling time)]. Plasma N-terminal pro-B natriuretic peptide (NT-pro-BNP) was also measured. The associations of dichotomous variables selected according to the Receiver Operator Characteristic analysis were assessed using the Cox proportional hazard model. Follow-up period was 37±18 months. Multivariate predictors of events were T-IVT≥12.3% s/min, mean E/Em ratio≥10, log NT-pro-BNP levels≥2.47 pg/ml and LV EF≤32.5%. On Kaplan-Meier analysis, patients with prolonged T-IVT, high mean E/Em ratio, increased NT-pro-BNP levels and decreased LV EF had a worse outcome compared with those without. The addition of T-IVT and NT-pro-BNP to conventional clinical and echocardiographic variables significantly improved the chi-square for the prediction of the outcome from 33.1 to 38.0, (P<0.001). Prolonged T-IVT added to the prognostic stratification of patients with systolic HF.International journal of cardiology 11/2009; 148(3):271-5. DOI:10.1016/j.ijcard.2009.09.567 · 4.04 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Although several studies have demonstrated a good correlation between Doppler echocardiographic and invasive measurements of single hemodynamic variables, the accuracy of echocardiography in providing a comprehensive assessment in individual patients has not been validated. The aim of this study was to assess the accuracy and clinical applicability of Doppler echocardiography in determining the entire hemodynamic profile in stable patients with advanced systolic heart failure. Doppler echocardiography and Swan-Ganz catheterization were simultaneously performed in 43 consecutive patients with advanced heart failure. Echocardiographic data required for estimation of right atrial, pulmonary artery systolic, and pulmonary capillary wedge pressures; cardiac output; and pulmonary vascular resistance were obtained and compared with hemodynamic data. For all variables, invasive and noninvasive hemodynamic values were highly correlated (P<0.0001), with very low bias and narrow 95% confidence limits. In 16 patients with elevated pulmonary vascular resistance (>3 Wood U) and pulmonary capillary wedge pressures (>20 mm Hg) at baseline, hemodynamic and Doppler measurements were simultaneously repeated after unloading manipulations. Absolute values and changes of pulmonary vascular resistance and pulmonary capillary wedge pressures after unloading were still accurately predicted (r =0.96 and r =0.92, respectively). Doppler echocardiography may offer a valid alternative to invasive cardiac catheterization for the comprehensive hemodynamic assessment of patients with advanced heart failure, and it may assist in monitoring and optimization of therapy in potential heart transplant recipients.Circulation Heart Failure 03/2010; 3(3):387-94. DOI:10.1161/CIRCHEARTFAILURE.108.809590 · 5.89 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.