Identification of long-term prognostic markers in heart failure patients with restrictive filling pattern using doppler echocardiography

Abstract

Background: Restrictive left ventricular filling pattern (RFP) is a well-known poor prognostic marker tn patients with congestive head failure (CHF). However, the information regardtng the prognostic marker in CHF patients with RFP is scarce. The aim of the present study was to look for long-term prognostic markers in CHF with RFP using echocardiography. Methods and results: 40 CHF patients (26 men, age = 5404 yrs) with RFP were followed for 35*19 months. Using Doppler echocardiography. early(E) and late(A) filling velocities, deceleration time(DT) of E wave, and early and late(A) mitral annulus velocities were measured. The reversibility of RFP was defined as a reversal of E/A ratio with Valsalva maneuver. Mean ejection fraction was 30.0-l 2.7%. During the follow-up period, 16 patients died of cardiac causes. Nonsurvivors showed lower A (0.29 vs 0.37 m/s, p = 0.04) and lower A’ (4.3 vs 5.3 cmls, p = 0.02). Also, mortality was higher in patients with irreversible RFP (52 vs 13 %, p = 0.01). However, left ventricular ejection fraction, DT of early filling and left atria size did not show significant difference. Multivariate analysis revealed A’ (p=O.O2), followed by A (p=O.O4), as the only independent predictor of subsequent cardiac death. Patients at high risk for fatal outcome could be identified by A’ < 4 cm/s (p = 0.030, C.I. = 0.000-0.000) and A < 0.32 m/s (p = 0.023, C.I. = 0.000 0.046) in Cox regression analysis. Conclusion: A’ and A were independent prognostic markers in CHF patients RFP.