Abstract 15943: Left Ventricular Regional Longitudinal Displacement Assessed by Tissue Doppler Imaging is a Powerful Predictor of All-cause Mortality in Patients With Systolic Heart Failure

Abstract

Objective: Tissue tracking (TT), obtained by tissue Doppler imaging (TDI), can be utilized to assess the mitral annular longitudinal displacement (LD) during systole. However, the prognostic utility of regional LD in patients with heart failure with reduced ejection fraction (HFrEF) is unknown. Methods: Transthoracic echocardiographic examinations from 911 patients with HFrEF were retrieved from a heart failure clinic’s database. The exams were performed from 2005 to 2013. The echocardiographic images were subsequently analyzed obtaining conventional echocardiographic measurements. Regional LD was obtained from the three apical TDI projections with sampling at six mitral annular sites located at the anterior, lateral, posterior, inferior, septal and anteroseptal myocardial walls. Results: During a median follow-up period of 40 months 150 (16.4 %) patients died. Patients that died had significantly lower LVEF (23.3% vs 28.3%, p<0.001) and lower regional LD in all six mitral annular sites (Figure). Many conventional echocardiographic parameters presented as predictors of mortality (LVEF, LVMI, LAVI, E, E/e’, deceleration time and TAPSE). However, only LD at the septal and inferior annular sites remained independent predictors of mortality in cox proportional-hazards models after adjusting for age, gender, BMI, total cholesterol, heart rate, atrial fibrillation, non-independent diabetes mellitus and the aforementioned conventional echocardiographic predictors (Figure). In addition, the septal and the inferior sites had the highest Harrell’s C-statistic of all the echocardiographic predictors (0.70 and 72, respectively). Conclusion: In patients with severe heart failure, septal and inferior LD are independent predictors of all-cause mortality. Furthermore, septal and inferior LD proved to be superior prognosticators when compared to all the conventional echocardiographic parameters.