April 15, 2011Annals of the Academy of Medicine Singapore23 citationsOpen Access
Attenuation of Stress-based Ventricular Contractility in Patients with Heart Failure and Normal Ejection Fraction
Structured PICO
Does the echocardiographic index dσ*/dtmax accurately diagnose heart failure with normal ejection fraction compared to normal controls?
P
Population
240 subjects including 100 healthy normal controls, 40 patients with heart failure and normal ejection fraction (HFNEF), and 100 patients with heart failure and reduced ejection fraction (HFREF).
I
Intervention
Echocardiographic measurement of stress-based contractility index dσ*/dtmax (maximal rate of change of pressure-normalised wall stress)
C
Comparator
Healthy normal controls and patients with HFREF
O
Outcome
Capacity of dσ*/dtmax to diagnose heart failure with normal ejection fraction (HFNEF)surrogate
The echocardiographic index dσ*/dtmax is significantly reduced in patients with HFNEF and may serve as a useful measure of left ventricular contractility for early diagnosis.
Limitations
- Relatively small sample size
- Uses a select referral-based retrospective population
- Lack of gold standard for the diagnosis of HFNEF impacts the selection of patients
Abstract
INTRODUCTION: The maximal rate of change of pressure-normalised wall stress dσ*/dtmax has been proposed as cardiac index of left ventricular (LV) contractility. In this study, we assessed the capacity of dσ*/dtmax to diagnose heart failure with normal ejection fraction (HFNEF). MATERIALS AND METHODS: One hundred healthy normal controls and 140 patients admitted with heart failure (100, HFREF and 40, HFNEF) underwent echocardiography for stress-based contractility dσ*/dtmax. Patients with signifi cant valvular heart disease were excluded. Tissue Doppler indices were also measured. RESULTS: dσ*/dtmax was 4.43 ± 1.27 s-1 in control subjects; reduced in HFNEF, 3.02 ± 0.98 s-1; and HFREF, 2.00 ± 0.67 s-1 (P 3.2 s-1) was 0.84 (P 2.32 s-1) was 0.88 (P <0.0001). CONCLUSION: This data confi rms that dσ*/dtmax on echocardiography is a powerful independent predictor in patients with HFNEF. In a population with a high suspicion of HFNEF, dσ*/dtmax may significantly contribute to early diagnosis and hence be useful in the triage and management of HFNEF patients.