Failing heart—medical aspect
Tissue Doppler Imaging in Patients with Advanced Heart Failure: Relation to Functional Class and Prognosis

https://doi.org/10.1016/j.healun.2005.09.002Get rights and content

Background

Tissue Doppler imaging (TDI) provides rapid assessment of systolic and diastolic myocardial function. However, the added value of TDI to standard Doppler echocardiographic measurements in predicting symptoms and outcome of advanced heart failure remains unknown.

Methods

The study cohort comprised 45 patients with congestive heart failure, defined as New York Heart Association functional class III and IV, who were referred to our department for evaluation for heart transplantation. Twenty healthy subjects were the controls. Conventional echo Doppler was used to assess left ventricular (LV) ejection fraction, peak velocities of transmitral early and late diastolic LV filling, the ratio of transmitral early to late LV filling velocity, and E-deceleration time. TDI measurements recorded at the mitral annulus included systolic velocity, early and late diastolic velocities, and the ratio of early to late diastolic velocity. The ratio of transmitral early LV filling velocity to early diastolic TDI velocity of the mitral annulus (E/E′) was calculated. All patients were followed for cardiac-related death and hospitalization for heart failure.

Results

Patients with functional class IV had a significantly higher E/E′ ratio than did patients with functional class III (12.9 ± 2.8 vs 8.3 ± 1.7, p < 0.001) and the controls (5.4 ± 1.3, p < 0.001). Except for transmitral late filling velocity, all conventional echo Doppler parameters and TDI variables significantly correlated with functional class. On multivariate stepwise analysis, however, the E/E′ ratio was the only independent predictor of functional class (p = 0.003). E/E′ also correlated with cardiac mortality and hospitalization.

Conclusion

Conventional Doppler indices and TDI parameters correlated with functional class in patients with advanced heart failure. The E/E′ ratio, which probably reflects high LV end-diastolic pressure, was the best measure for differentiating patients with functional class III and IV, and it also correlated with cardiac mortality and hospitalization for worsening heart failure, thereby providing additional value to standard echocardiographic measures.

Section snippets

Patients

The study group consisted of 45 patients (37 men, 8 women; mean age, 57.5 ± 10.9 years; range, 26–75 years) with congestive heart failure who were referred to our department for evaluation for heart transplantation between 1998 and 2001. Twenty-six patients (58%) had New York Heart Association functional class III, and 19 (42%) had functional class IV. Patients with a prosthetic mitral valve or significant mitral valve calcification were excluded. The cause of heart failure was ischemic

Results

During follow-up, 6 patients received transplants (13%), 15 patients (33%) were hospitalized for worsening heart failure, and 5 patients (11%) died of cardiac causes (acute coronary syndrome with non Q-wave myocardial infarction in 2, heart failure in 2, sudden death in 1), and 1 patient died of rejection.

Discussion

In the present study of the relationship of mitral annular velocities and clinical manifestations in patients with significant LV dysfunction, E/E′ was the only independent predictor of functional class. It also correlated with cardiac mortality and hospitalization for heart failure. Except for transmitral late diastolic velocity, all TDI parameters, as well as ejection fraction and mitral inflow variables, correlated with functional class. This finding emphasizes the important contribution of

Conclusion

Conventional Doppler indices and TDI parameters correlated with functional class in patients with significant LV dysfunction and advanced heart failure. However, the E/E′ ratio usefully discriminated patients with functional class III from patients with functional class IV, emphasizing the role of LV end-diastolic pressure in producing cardiac symptoms in these patients. The E/E′ ratio also predicted the clinical outcome.14

References (28)

Cited by (45)

  • Myocardial performance index derived from pre-ejection period as a novel and useful predictor of cardiovascular events in atrial fibrillation

    2015, Journal of Cardiology
    Citation Excerpt :

    In addition, use of the index beat to measure PEPa-derived MPI in AF patients was as accurate as the time-consuming method of averaging multiple cardiac cycles. Several studies have explored the prognostic role of Doppler tissue image-derived parameters in major cardiac diseases such as heart failure [24], acute myocardial infarction [25], and hypertension. The Ea, E/Ea, and Sa are shown to predict mortality or CV events in these cardiac diseases.

  • The ratio of early mitral inflow velocity to global diastolic strain rate as a useful predictor of cardiac outcomes in patients with atrial fibrillation

    2014, Journal of the American Society of Echocardiography
    Citation Excerpt :

    Hence, assessment of E/E′sr in patients with AF may help identify the high-risk group with poor cardiac outcomes. Several studies have explored the prognostic role of Doppler tissue image–derived parameters in major cardiac diseases such as heart failure, acute myocardial infarction, and hypertension.22,23 E′ and E/E′ ratio were shown to predict mortality or cardiovascular events in these cardiac diseases.

  • The physiological impact of intermittent sequential pneumatic compression (ISPC) leg sleeves on cardiac activity

    2011, American Journal of Surgery
    Citation Excerpt :

    Taking into account the ability of TDI to detect myocardial strain, the increased value of the parameter TDI velocity and Med E′ in our study subjects indicated fair cardiac adaptation in response to increased preload following ISPC activation.29,30 The decrease in the calculated value of the E/Med E′ ratio supplied additional data to exclude diastolic dysfunction (compliance abnormalities31,32). Several studies have been conducted concerning the cardiovascular influence of different types of pneumatic sleeves, without definitive conclusions or a comprehensive analysis of the relevant pathophysiologic data.

View all citing articles on Scopus
View full text