Reduced systolic performance by tissue Doppler in patients with preserved and abnormal ejection fraction: New insights in chronic heart failure

Abstract

Background Tissue Doppler imaging (TDI) is useful in the evaluation of systolic and diastolic function. It allows assessment of ventricular dynamics in its longitudinal axis. We sought to investigate the difference in systolic and diastolic longitudinal function in patients with chronic heart failure (CHF) with normal and reduced ejection fraction. Methods and Results One hundred ten outpatients with CHF and 68 controls were included. Ejection fraction (EF) was obtained and longitudinal systolic ( S) and diastolic ( E′ and A′) wall velocities were recorded from basal septum. Group A (controls) were normal and CHF patients were classified by EF in Group B1: > 45% and B2: ≤ 45%. In A, B1 and B2 the mean S peak was 7.74; 5.45 and 4.89 cm/s ( p < 0.001); the mean E′ peak was 8.56; 5.72 and 6.1 cm/s ( p < 0.001); and the mean A′ peak was 10.2; 7.3 and 5.3 cm/s ( p < 0.001). Also, isovolumic contraction and relaxation time were different among control and CHF groups, (both p < 0.001). The most useful parameters for identifying diastolic CHF were IVRT and S peak, with area under ROC curves of 0.93 and 0.89. The cut-off of 115 ms for IVRT and 5.8 cm/s for S peak showed a sensitivity of 94 and 97%, with a specificity of 82 and 73%, respectively. Conclusion These findings suggest that impairment of left ventricular systolic function is present even in those with diastolic heart failure, and that abnormalities may have an important role to identifying the condition.