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摘要
Background: It has been shown that a new tissue Doppler index, E/(E'xS'), including the ratio between early diastolic transmitral and mitral annular velocity (E/E'), and the systolic mitral annular velocity (S'), has a good accuracy to predict left ventricular filling pressure. Objectives: We investigated the value of E/(E'xS') to predict cardiac death in patients with heart failure. Methods: Echocardiography was performed in 339 consecutive hospitalized patients with heart failure, in sinus rhythm, after appropriate medical treatment, at discharge and after one month. Worsening of E/(E'xS') was defined as any increase of baseline value. The end point was cardiac death. Results: During the follow-up period (35.2 +/- 8.8 months), cardiac death occurred in 51 patients (15%). The optimal cut-off value for the initial E/(E'xS') to predict cardiac death was 2.83 (76% sensitivity, 85% specificity). At discharge, 252 patients (74.3%) presented E/(E'xS') <= 2.83 (group I) and 87 (25.7%) presented E/(E'xS') > 2.83 (group II), respectively. Cardiac death was significantly higher in group II than in group I (38 deaths, 43.7% vs. 13 deaths, 5.15%, p < 0.001). By multivariate Cox regression analysis, including variables that affected outcome in univariate analysis, E/(E'xS') at discharge was the best independent predictor of cardiac death (hazard ratio = 3.09, 95% confidence interval = 1.81-5.31, p = 0.001). Patients with E/(E'xS') > 2.83 at discharge and its worsening after one month presented the worst prognosis (all p < 0.05). Conclusions: In patients with heart failure, the E/(E'xS') ratio is a powerful predictor of cardiac death, particularly if it is associated with its worsening.
- 出版日期2014-1
