European Journal of Echocardiography Advance Access originally published online on February 27, 2009
European Journal of Echocardiography 2009 10(4):562-566; doi:10.1093/ejechocard/jep001
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Value of tissue Doppler imaging for risk stratification of patients with chronic systolic heart failure with or without restrictive mitral flow
1 Unità Malattie Cardiovascolari 2, Ospedale S. Chiara, Azienda Ospedaliera-Universitaria Pisana, Via Roma, 67, 56126 Pisa, Italy
2 Dipartimento di Medicina Interna e Specialità Mediche, Azienda Ospedaliera-Universitaria San Martino, Genova
Received 9 July 2008; accepted after revision 11 January 2009; online publish-ahead-of-print 27 February 2009.
* Corresponding author. Tel: +39 050 992355; fax: +39 050 993114. E-mail address: f.dini{at}ao-pisa.toscana.it
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Abstract |
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Aims: The aim of this study was to assess the prognostic value of tissue Doppler imaging (TDI) in patients with chronic systolic heart failure (HF) with or without restrictive mitral flow (RMF).
Methods and results: Echocardiograms were obtained in 378 patients with chronic systolic HF [ejection fraction (EF) 
45%] in sinus rhythm. Restrictive mitral flow was defined by an E wave deceleration time (EDT) 140 ms. Tissue Doppler imaging early (Em) diastolic and systolic (Sm) velocities were measured at the mitral annulus. Patients were followed-up for a median of 32 months. Endpoints were all-cause mortality and the combination of death or HF hospitalization. Mean left ventricular EF was 32 ± 8%. Restrictive mitral flow and TDI annular velocities were all univariate predictors of the endpoints. Ejection fraction <25% was the only multivariate predictor of all-cause mortality. E wave deceleration time and Em < 8 cm/s were independently associated with the combined endpoint of death or HF hospitalization. At 48 months, survival was 61% in patients with RMF and 82% in patients with non-RMF (log-rank: 21.6; P < 0.0001). When patients were stratified according to Em at or above 8 cm/s or below 8 cm/s, those with RMF and Em < 8 cm/s exhibited the worst survival (log-rank: 27.16; P < 0.0001). Patients with Sm 6 cm/s had a 58% survival rate, whereas it was 82% in patients with Sm > 6 cm/s (log-rank: 12.73; P = 0.0004).
Conclusion: Doppler annular velocities provided useful information for prognostication of patients with systolic HF. Particularly, categorization of patients according to Em velocities allowed us to further stratify patients with RMF and non-RMF.
Keywords: Heart failure; Tissue Doppler imaging; Prognosis