Failing heart—medical aspectTissue Doppler Imaging in Patients with Advanced Heart Failure: Relation to Functional Class and Prognosis
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)
- et al.
Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction
JAMA
(1996) - et al.
Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure
JAMA
(1994) - et al.
Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans
JAMA
(1987) - et al.
Tissue Doppler imaginga useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function
J Am Soc Echocardiogr
(2001) - et al.
Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function
JAMA
(1997) - et al.
Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation
Am J Cardiol
(1997) - et al.
Doppler tissue imaginga noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressure
JAMA
(1997) - et al.
Prognostic value of the atrial systolic mitral annular motion velocity in patients with left ventricular systolic dysfunction
J Am Soc Echocardiogr
(2003) - et al.
Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value
JAMA
(2003) - et al.
Congestive heart failure in subjects with normal versus reduced left ventricular ejection fractionprevalence and mortality in a population-based cohort
JAMA
(1999)
The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography
J Am Soc Echocardiogr
New Doppler echocardiographic applications for the study of diastolic function
JAMA
Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function
JAMA
Mitral annular descent velocity by tissue Doppler echocardiography as index of global left ventricular function
Am J Cardiol
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