Visual echocardiographic scoring system of the left ventricular filling pressure and outcomes of heart failure with preserved ejection fraction

Figures

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  Figure 1. VMT scoring. Apical four-chamber views in early diastole (upper panels) and corresponding subcostal views (lower panels) are presented. Time sequence of opening of MV and TV was visually assessed in the apical four-chamber view and scored as follows: 0, TV opening first; 1, simultaneous; and 2, MV opening first. When the IVC diameter was >21 mm and collapsed to <20% during normal respiration, 1 point was added and VMT score was calculated as 4 grades from 0 to 3. Orange dashed circles highlight the atrioventricular valves which open in early diastole. IVC, inferior vena cava; LV, left ventricular; MV, mitral valve; TV, tricuspid valve; VMT, visually assessed time difference between MV and TV opening.

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  Figure 2. Kaplan–Meier analysis of event-free survival. (A) A composite outcome of cardiac mortality or HF hospitalization in the overall patients, (B) a composite outcome of all-cause mortality or HF hospitalization in the overall patients, (C) a composite outcome of cardiac mortality or HF hospitalization in AF patients, and (D) a composite outcome of all-cause mortality or HF hospitalization in AF patients. AF, atrial fibrillation; HF, heart failure; VMT, visually assessed time difference between mitral valve and tricuspid valve opening.

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  Figure 3. Kaplan–Meier analysis of event-free survival in indeterminate LV filling pressure subgroup by the 2016 ASE/EACVI guidelines. (A) A composite outcome of cardiac mortality or HF hospitalization and (B) a composite outcome of all-cause mortality or HF hospitalization. HF, heart failure; LV, left ventricular; VMT, visually assessed time difference between mitral valve and tricuspid valve opening.

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  Figure 4. Incremental prognostic value of VMT score. Addition of VMT score to clinical variables (age, sex, BNP, AF) and DD grade significantly increased the predictive ability for cardiac mortality or HF hospitalization. AF, atrial fibrillation; BNP, B-type natriuretic peptide; DD grade, LV diastolic dysfunction grade by the 2016 ASE/EACVI recommendations; HF, heart failure; LV, left ventricular; VMT, visually assessed time difference between mitral valve and tricuspid valve opening.

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  Figure 5. Receiver operating curve analysis of incremental association value of the VMT score when added to the LV diastolic dysfunction grade by the 2016 ASE/EACVI recommendations. CI, confidence interval; DD grade, LV diastolic dysfunction grade by the 2016 ASE/EACVI recommendations; LV, left ventricular; VMT, visually assessed time difference between mitral valve and tricuspid valve opening.