Abstract 12874: E/e’ SV is a Better Predictor of Outcome Than E/e’ in Patients With Heart Failure With Preserved Left Ventricular Ejection Fraction

Abstract

Introduction: Predictors of outcome in patients with heart failure with preserved left ventricular ejection fraction (HFpEF) remain unclear. The ratio of early diastolic transmitral flow velocity to early diastolic myocardial velocity (E/e’) has been proposed as one of them, but the predictive accuracy remains insufficient. Hypothesis: We hypothesized E/e’ SV, E/e’ normalized by the stroke volume (SV), may be a better predictor of outcome in patients with HFpEF than E/e’, by reflecting the terminal slope of the end-diastolic pressure-volume relation, i.e., stiffness of the left ventricle. The aims of this study were to propose a novel echocardiographic index, E/e’ SV, and investigate the feasibility and accuracy of this method in HFpEF patients. Methods: Echocardiography including E/e’ SV measurement was performed in consecutive 43 patients with HFpEF at discharge in index hospitalization (female 22 patients (51%), age 78±9 years old). Patients were followed for a median of 6.5 months. The end points included the admission for heart failure and cardiovascular death. Results: During the follow-up, 9 patients (21%) encountered the end points. In ROC analysis, E/e’ SV was a better predictive factor than E/e’ (E/e’ SV: AUC=0.820; E/e’: AUC=0.768). Kaplan-Meier analysis showed patients with E/e’ SV>0.420 had a poorer prognosis than those with E/e’ SV<0.420 (P<0.01). In Cox regression multivariate analysis, high E/e’ SV was an independent predictor of event-free survival (Adjusted Hazard ratio [95% CI] = 17.2 [3.1, 94.8] (p=0.001)). Conclusion: E/e’ SV is a better predictor of outcome in patients with HFpEF than E/e’.