Article

A comparison of echocardiographic measures of diastolic function for predicting all-cause mortality in a predominantly male population

Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA.
American heart journal (Impact Factor: 4.56). 03/2011; 161(3):530-7. DOI: 10.1016/j.ahj.2010.12.010
Source: PubMed

ABSTRACT Prior studies demonstrating the prognostic value of echocardiographic measures of diastolic function have been limited by sample size, have included only select clinical populations, and have not incorporated newer measures of diastolic function nor determined their independent prognostic value. The objective of this study is to determine the independent prognostic value of established and new echocardiographic parameters of diastolic function.
We included 3,604 consecutive patients referred to 1 of 3 echocardiography laboratories over a 2-year period. We obtained measurements of mitral inflow velocities, pulmonary vein filling pattern, mitral annulus motion (e'), and propagation velocity (V(p)). The primary end point was 1-year all-cause mortality.
The mean age of the patients was 68 years, and 95% were male. There were 277 deaths during a mean follow-up of 248 ± 221 days. For patients with reduced left ventricular ejection fraction (LVEF), all measured parameters except for e' were associated with mortality (P < .05) on univariate analysis. For patients with preserved LVEF, the E-wave velocity was significantly associated with mortality (P < .05) on univariate analysis. The deceleration time/E-wave velocity ratio, V(p), and pulmonary vein filling pattern were borderline significant (P < .10). With multivariate analysis, only V(p) was associated with survival for both reduced (P = .02) and preserved LVEF groups (P = .01).
In a large, clinically diverse population, most measures of diastolic function were predictive of all-cause mortality without adjustment for patient characteristics. On multivariate analysis, only V(p) was independently associated with total mortality. This association with mortality may be related to factors other than diastolic function and warrants further investigation.

0 Bookmarks
 · 
93 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim: Assessment of the occurrence, severity and progress of the diastolic dysfunction in patients with clinically manifest heart failure with preserved systolic function, by analyzing the ultrasound parameters that define the diastolic ventricular function, recorded dynamically. Material and Method: The study involved 200 patients suffering from clinically manifest heart failure, admitted in Cardiology Department of Medical no 1, Cluj-Napoca; an echocardiographic study of the systolic and diastolic function was performed, by the same person, for each of them. The echocardiographic study was carried out dynamically, at first within 3 days of the first examination, then, after 9 months. In the present study we selected patients with an ejection fraction> = 50% and diastolic dysfunction. Results: Of the 200 patients initially evaluated, 43 patients were selected based on the inclusion criteria for diastolic dysfunction. The E '/ A' ratios in the lateral regions of the mitral annulus showed a statistically significant improvement when dynamically assessed (0.71 versus 0, 6, p = 0.016). Also, E / E' ratio in the lateral portion of the mitral annulus significantly improved (6.15 vs. 5.44, p = 0.016) and MPI dynamical assessment shows a statistically significant improvement in this parameter (0.52 vs. 0.46 p = 0.014). Conclusions: Diastolic function assessment should be an integral part of the cardiac function assessment due to the increased prevalence of the patients with HF and preserved systolic function. Our study showed that the most reliable parameters used to assess the diastolic dysfunction in patients with preserved systolic function are the following: the E '/ A' ratio at the level of the septum, the E / E' ratio at the level of the lateral wall, as well as the MPI estimate.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To study the prognostic value of carbohydrate antigen 125 (CA125) and whether it adds prognostic information to N-terminal pro-brain natriuretic peptide (NT-proBNP) in stable heart failure (HF) patients. The predictive value of CA125 was retrospectively assessed in 156 patients with stable HF remitted to the outpatient HF unit for monitoring from 2009 to 2011. Patients were included in the study if they had a previous documented episode of HF and received HF treatment. CA125 and NT-proBNP concentrations were measured. The independent association between NT-proBNP or CA125 and mortality was assessed with Cox regression analysis, and their combined predictive ability was tested by the integrated discrimination improvement (IDI) index. The mean age of the 156 patients was 72 ± 12 years. During follow-up (17 ± 8 mo), 27 patients died, 1 received an urgent heart transplantation and 106 required hospitalization for HF. Higher CA125 values were correlated with outcomes: 58 ± 85 KU/L if hospitalized vs 34 ± 61 KU/L if not (P < 0.05), and 94 ± 121 KU/L in those who died or needed urgent heart transplantation vs 45 ± 78 KU/L in survivors (P < 0.01). After adjusting for propensity scores, the highest risk was observed when both biomarkers were elevated vs not elevated (HR = 8.95, 95%CI: 3.11-25.73; P < 0.001) and intermediate when only NT-proBNP was elevated vs not elevated (HR = 4.15, 95%CI: 1.41-12.24; P < 0.01). Moreover, when CA125 was added to the clinical model with NT-proBNP, a 4% (P < 0.05) improvement in the IDI was found. CA125 > 60 KU/L identified patients in stable HF with poor survival. Circulating CA125 level adds prognostic value to NT-proBNP level in predicting HF outcomes.
    World Journal of Cardiology (WJC) 04/2014; 6(4):205-12. DOI:10.4330/wjc.v6.i4.205 · 2.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the present study was to determine whether diastolic dysfunction (DD) is associated with outcomes in the absence of myocardial ischemia. We studied 2,835 patients undergoing exercise echocardiography from January 2006 through December 2006 who had normal systolic function (ejection fraction ≥50%) and an absence of exercise-induced wall motion abnormalities. Diastolic function was graded as normal, mild DD, or moderate to severe DD. Medical records review and patient contact were undertaken to determine mortality, cardiovascular events (i.e., death, myocardial infarction, or stroke), incident heart failure (HF), and hospitalization. The mean ± SD age was 58.9 ± 12.8 years, and 54.0% were women. DD was present in 40.0% of the participants, with mild DD in 28.2% and moderate to severe DD in 11.8%. During a median follow-up of 4.4 years, 81 deaths and 114 cardiovascular events occurred, and DD was associated with greater rates of mortality, cardiovascular events, and HF events or hospitalizations (all p <0.001). On multivariate analysis, mild or moderate to severe DD (referent, normal function) was associated with HF or hospitalization (hazard ratio 1.45, 95% confidence interval 1.18 to 1.78, p <0.001 for mild DD; hazard ratio 1.75, 95% confidence interval 1.37 to 2.24, p <0.001 for moderate to severe DD) but was not independently associated with death or cardiovascular events. The diastolic index of filling pressure (E/e') was independently associated with mortality, cardiovascular events, and HF or hospitalization. In conclusion, among patients without demonstrable myocardial ischemia, left ventricular DD was associated with greater event rates during long-term follow up but did not independently predict hard end points other than HF or hospitalization. E/e' was independently associated with the clinical outcomes and might be an important echocardiographically derived parameter to identify in patients undergoing exercise echocardiography.
    The American journal of cardiology 04/2013; DOI:10.1016/j.amjcard.2013.03.009 · 3.58 Impact Factor

Preview

Download
0 Downloads
Available from