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

Abstract

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). 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. 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.