Left Ventricular Outflow Tract and Pulmonary Artery Stroke Distances Independently Predict Heart Failure Hospitalization and Mortality: The Heart and Soul Study

• Published in: Journal of the American Society of Echocardiography Vol. 24; no. 5; pp. 565 - 572
• Main Authors: Ristow, Bryan, MD, Na, Beeya, MPH, Ali, Sadia, MD, MPH, Whooley, Mary A., MD, Schiller, Nelson B., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-05-2011
• Subjects: Aged; Blood Pressure; Cardiovascular; Confidence Intervals; Doppler echocardiography; Female; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - pathology; Heart Rate; Hospitalization; Humans; Male; Prognosis; Prospective Studies; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - pathology; Stroke - diagnostic imaging; Stroke - mortality; Stroke - pathology; Stroke distance; Stroke Volume; Ultrasonography, Doppler; United States; Velocity time integral; Ventricular Function, Left; Ventricular Outflow Obstruction - diagnostic imaging; Ventricular Outflow Obstruction - pathology; Heart failure; LVEF; HR; LVOT; Hazard ratio; Pulmonary artery; Stroke distance; PA; Doppler echocardiography; Velocity time integral; Left ventricular ejection fraction; Left ventricular outflow tract; HF
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2010.12.024

Background Stroke distance of the left ventricular outflow tract (LVOT) or pulmonary artery (PA) is readily measurable by Doppler echocardiography. Stroke distance, calculated by the velocity time integral, expresses the average linear distance traveled by red blood cells during systole. We hypothesized that reduced stroke distance predicts heart failure (HF) hospitalization or mortality among ambulatory adults with stable coronary artery disease. Methods We compared stroke distances by lowest quartile among 990 participants in the Heart and Soul Study. We calculated hazard ratios (HRs) for events adjusted for clinical and echocardiographic parameters. Results At 5.9 ± 1.9-year follow-up, there were 154 HF hospitalizations and 271 all-cause deaths. Among 254 participants with LVOT stroke distance in the lowest quartile (≤18 cm), 24% developed HF hospitalization, compared with 10% of those with higher stroke distance (HR 2.7; CI, 2.0–3.8; P < .0001). This association remained after adjustment for multiple variables including medical history, heart rate, blood pressure, and left ventricular ejection fraction (HR 1.8; CI, 1.1–3.0; P  = .02). Both LVOT stroke distance ≤18 cm and PA stroke distance ≤17 cm were independently associated with the combined end point of HF hospitalization and mortality (HR 1.4; CI, 1.1-1.9; P  = .02). Conclusion Reduced stroke distance predicts HF hospitalization and mortality independent of clinical and other echocardiographic parameters among ambulatory adults with coronary artery disease.