Key result
Impaired diastolic filling grade 2, 3, or 4 was associated with a 76% event rate for MI, stroke, or death in patients with ejection fraction ≤30%.
Why the study?
Do baseline and serial changes in systolic and diastolic echocardiographic indices predict outcomes in patients with decreased left ventricular ejection fraction (≤30%)?
Cohort (n=110)
Do baseline and serial changes in systolic and diastolic echocardiographic indices predict outcomes in patients with decreased left ventricular ejection fraction (≤30%)?
In patients with severe left ventricular dysfunction, serial changes in echocardiographic indices of systolic and diastolic function, as well as LV mass, are better predictors of adverse outcomes than baseline ejection fraction alone.
Supports diastolic grading for prognostication in LVEF ≤30%; leaves open whether serial changes outperform baseline EF.
BACKGROUND: Echocardiographic estimation of left ventricular ejection fraction aids in predicting adverse outcomes in coronary artery disease. However, in patients with impaired left ventricular function, further risk stratification is difficult. METHODS: A 2 year retrospective review was performed to identify patients with ejection fraction < or=30%. Echocardiographic measures of systolic and diastolic function were independently performed offline. Outcome information, which included MI, stroke, or death, was obtained. The patient cohort identified those with follow-up having 1) a single echocardiogram and a subset 2) with an initial echocardiogram and a second echocardiogram at greater than one year follow-up. RESULTS: This study included 110 patients, ages 20-94. Mean follow-up time was 29+/-9 months. Ejection fraction did not predict cardiovascular events. LV mass predicted of mortality (p=0.03). Diastolic indexes of mitral inflow E wave was a significant predictor of outcome (p=0.05). Impaired diastolic filling grade 2, 3, or 4 showed a 76% event rate. Decreases in ejection fraction at follow-up were seen in those who had an event, with an average decrease in ejection fraction of 17% versus those who lived with no event of 1%. Changes in mitral inflow E wave and changes in E/A ratio were both significant predictors of outcome. CONCLUSIONS: These data indicate that echocardiographic measures of both systolic and diastolic function aid in risk stratifying patients with decreased ejection fraction. The changed detected in serial echocardiographic information may be important in treatment and secondary prevention of future events.
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Bierig et al. (2006) conducted a cohort in decreased left ventricular ejection fraction (n=110). Echocardiographic measures of systolic and diastolic function was evaluated on MI, stroke, or death. Impaired diastolic filling grade 2, 3, or 4 was associated with a 76% event rate for MI, stroke, or death in patients with ejection fraction ≤30%.
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