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Year : 2018  |  Volume : 28  |  Issue : 2  |  Page : 95-100

Prognostic value of a tissue doppler index of systodiastolic function in patients with asymptomatic heart failure

1 Cardio Thoracic and Vascular Department, University of Pisa, Pisa, Italy
2 Villa Sofia Hospital, Palermo, Italy
3 ”San Giovanni di Dio e Ruggiero d'Aragona” Hospital, Salerno, Italy
4 Cardiology University Department, Bari, Italy
5 Monaldi Hospital, Napoli, Italy
6 ”Bianchi-Melacrino-Morelli” Hospital, Reggio Calabria, Italy
7 ”S.Maria degli Angeli” Hospital, Pordenone, Italy
8 ”Sant'Anna School of Advanced Studies, Pisa, Italy
9 Clinical and Experimental Medicine, Messina, Italy

Correspondence Address:
Nicola Riccardo Pugliese
Dipartimento Di Patologia Medica, Chirurgica, Molecolare E Dell'area Critica, Università Di Pisa, Via Paradisa, 2 - Ospedale Cisanello, 56100 Pisa PI
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcecho.jcecho_59_17

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Introduction: Doppler echocardiography with early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (E') ratio has been proposed as the best predictor for evaluating left ventricle (LV) filling pressure. A dimensionless index E/(E' × S') ratio (S' = systolic mitral annulus velocity) resulted in readily, reproducible, and reliable predictor of LV filling pressure. We assessed the prognostic impact of E/(E' × S') in patients with asymptomatic heart failure (HF). Materials and Methods: We calculated E/(E' × S') in 337 patients (179 male, 53%; age 54.7 ± 13.7 years) using the average of septal and lateral mitral annular velocities. We considered a composite endpoint as follows: all-cause death, acute myocardial infarction, stroke, and HF exacerbation. Results: Baseline ejection fraction resulted 60.2 ± 11.8%; E/(E' × S') was 1.45 ± 0.8, with S' 7.4 ± 2.4 cm/s and E/E' 9.5 ± 5.4. After a 22-month median follow-up, there were 42 events: 5 deaths (12%), 3 acute myocardial infarctions (7%), 1 stroke (2%), and 33 HF hospitalizations (79%). In patients reaching the composite endpoint, E/(E' × S') resulted 2.07 ± 1.1 versus 1.3 ± 0.7 in event-free population (P < 0.001). In a Cox-regression analysis, adjusted for confounding clinical factors and conventional echo parameters, E/(E' × S') (P < 0.001), age (P < 0.001), and male gender (P = 0.03) resulted independent predictors of the composite endpoint. Conclusions: E/(E' × S') was an independent predictor for the future cardiac events in asymptomatic HF.

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