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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/13429

Title: Impact of Left Ventricular Remodeling on Diagnostic and Prognostic Value of Tissue Doppler Indices in Chronic Systolic Heart Failure
Authors: Tang, W. H. Wilson
Shrestha, Kevin
Mullens, Wilfried
Borowski, Allen G.
Martin, Maureen G.
Troughton, Richard W.
Klein, Allan L.
Issue Date: 2011
Citation: JOURNAL OF CARDIAC FAILURE, 17 (2), p. 128-134
Abstract: Background The ratio of peak transmitral pulsed Doppler early velocity to early diastolic tissue Doppler velocity (TDI) of the lateral or septal mitral annulus (E/Ea) is considered a reliable estimation of LV filling pressure. We aim to examine the impact of left ventricular (LV) dimensions on the relationship between lateral and septal E/Ea in the determination of diastolic dysfunction patterns in the setting of chronic systolic heart failure (HF). Methods and Results In 207 patients with chronic systolic HF (LV ejection fraction ≤40%, New York Heart Association Classes I-IV), comprehensive transthoracic echocardiography was performed and long-term outcomes followed up to a median of 40 months. The median lateral and septal Ea (interquartile range) were 7.0 (4.7 to 9.5) cm/s and 4.5 (3.5 to 5.6) cm/s, respectively. The median E/lateral Ea, E/septal Ea, and E/average Ea (interquartile range) were 10.8 (7.1 to 15.1), 16.1 (11.1 to 23.0), and 12.7 (8.8 to 17.7), respectively. In the first 2 tertiles of indexed left ventricular end-diastolic volume (LVEDVi) (<92 mL/m2 and 92 to 130 mL/m2), all 3 E/Ea indices rise with increasing diastolic stage (all P < .001). However, in the highest tertile of indexed LVEDVi (≥130 mL/m2), E/average Ea and E/septal Ea (but not E/lateral Ea) increased with increasing diastolic stage, and only E/septal Ea correlated with natriuretic peptide levels (r = 0.38, P = .018) and adverse cardiac events (Hazard ratio 1.91, 95% confidence interval 1.25 to 2.96, P = .003). Conclusions In the setting of chronic systolic heart failure with extensive cardiac remodeling, septal TDI measurements may be more reliable and clinically relevant than lateral TDI measurements in the assessment of diastolic dysfunction.
URI: http://hdl.handle.net/1942/13429
DOI: 10.1016/j.cardfail.2010.10.001
ISI #: 000287466600006
ISSN: 1071-9164
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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