Ratio of transmitral early filling velocity to early diastolic strain rate predicts outcomes in patients with systolic heart failure

• Published in: European heart journal cardiovascular imaging Vol. 18; no. 1; pp. 79 - 85
• Main Authors: Chan, Yi-Hsin, Lee, Hsin-Fu, Wu, Lung-Sheng, Wang, Chun-Li, Wu, Chia-Tung, Yeh, Yung-Hsin, Ho, Y. Wan-Jing, Hsu, Lung-An, Chu, Pao-Hsien, Kuo, Chi-Tai
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-01-2017
• Subjects: Aged; Analysis of Variance; Blood Flow Velocity; Cause of Death; Cohort Studies; Echocardiography, Doppler - methods; Female; Heart Failure, Systolic - diagnostic imaging; Heart Failure, Systolic - mortality; Heart Failure, Systolic - physiopathology; Heart Failure, Systolic - surgery; Heart Transplantation; Humans; Image Interpretation, Computer-Assisted; Kaplan-Meier Estimate; Male; Middle Aged; Mitral Valve - physiopathology; Multivariate Analysis; Predictive Value of Tests; Proportional Hazards Models; Retrospective Studies; Severity of Illness Index; Stroke Volume - physiology; Survival Analysis; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Ventricular Pressure; Waiting Lists; heart failure; diastolic function; speckle-tracking strain; prognosis
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jew015

Aims The ratio of transmitral early filling velocity (E) to early diastolic tissue velocity (E′) is a key diastolic function parameter. The early diastolic strain rate (E′sr) has been proposed as a substitute for E′ in the E/E′ ratio for better estimation of left ventricular (LV) filling pressure. This study aims to assess the predictive value of combined E/E′sr ratio and global longitudinal strain (GLS) for prognosis in systolic heart failure (SHF).
Methods and results We retrospectively analysed 330 SHF patients with an LV ejection fraction (LVEF) ≤ 40%. Study end points were defined as all-cause mortality or heart transplantation. The incremental value of GLS and the E/E′sr ratio over LVEF and E/E′ for outcome prediction was assessed using nested Cox models. Ninety-nine (30%) patients reached the end point over a median follow-up of 46 months. Baseline variables associated with outcomes were age, glomerular filtration rate, pulmonary artery systolic pressure, and LV end-systolic volume index. After multivariate adjustment, GLS (hazard ratio: 1.48, P = 0.025) and the E/E′sr ratio (hazard ratio: 1.41, P = 0.002) were both independent predictors. LVEF or E/E′ was not an independent predictor when GLS and E/E′sr were included in the model. Patients with impaired GLS (absolute value <7.5%) and elevated E/E′sr ratios (E/E′sr ≥ 195 cm) showed poor outcomes.
Conclusion The E/E′sr ratio is stronger than E/E′ ratio in predicting prognosis of patients with systolic HF. Combined assessments of GLS and E/E′sr by speckle-tracking longitudinal strain facilitate risk stratification of these patients.