Prognostic value of a tissue doppler index of systodiastolic function in patients with asymptomatic heart failure

Introduction: Doppler echocardiography with early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (E') ratio has been proposed as the best predictor for evaluating left ventricle (LV) filling pressure. A dimensionless index E/(E' x S') ratio (S' = systolic mitral annulus velocity) resulted in readily, reproducible, and reliable predictor of LV filling pressure. We assessed the prognostic impact of E/(E' x S') in patients with asymptomatic heart failure (HF). Materials and Methods: We calculated E/(E' x S') in 337 patients (179 male, 53%; age 54.7 +/- 13.7 years) using the average of septal and lateral mitral annular velocities. We considered a composite endpoint as follows: all-cause death, acute myocardial infarction, stroke, and HF exacerbation. Results: Baseline ejection fraction resulted 60.2 +/- 11.8%; E/(E' x S') was 1.45 +/- 0.8, with S' 7.4 +/- 2.4 cm/s and E/E' 9.5 +/- 5.4. After a 22-month median follow-up, there were 42 events: 5 deaths (12%), 3 acute myocardial infarctions (7%), 1 stroke (2%), and 33 HF hospitalizations (79%). In patients reaching the composite endpoint, E/(E' x S') resulted 2.07 +/- 1.1 versus 1.3 +/- 0.7 in event-free population (P < 0.001). In a Cox-regression analysis, adjusted for confounding clinical factors and conventional echo parameters, E/(E' x S') (P < 0.001), age (P < 0.001), and male gender (P = 0.03) resulted independent predictors of the composite endpoint. Conclusions: E/(E' x S') was an independent predictor for the future cardiac events in asymptomatic HF.