Key result
A decrease in an initially high e'/a' ratio after 6 months of therapy independently predicted a lower risk of cardiac events in patients with chronic heart failure (HR 0.327).
Why the study?
Does a reversible high e'/a' ratio on Doppler tissue imaging predict a more favorable outcome in patients with chronic heart failure?
Cohort (n=181)
No
Does a reversible high e'/a' ratio on Doppler tissue imaging predict a more favorable outcome in patients with chronic heart failure?
Hazard Ratio: 0.327 (95% CI 0.18–0.595)
p-value: p=<0.001
In clinically stable patients with chronic heart failure, a decrease in an initially high e'/a' ratio on Doppler tissue imaging after 6 months of therapy independently predicts a lower risk of cardiac death or hospitalization.
May support serial e'/a' monitoring for prognostication in chronic HF; leaves open need for prospective validation before guiding therapy.
BACKGROUND: Early (e')/late (a') diastolic mitral annular velocity ratio is a powerful independent predictor of poor prognosis in patients with left ventricular (LV) dysfunction. Doppler tissue imaging, however, may change over time according to intervention and medical treatment. The aim of the present study was to prospectively evaluate whether, in clinically stable patients with chronic heart failure (CHF), the decrease of an initially high e'/a' ratio on long-term therapy predicts a more favorable outcome. METHODS AND RESULTS: One hundred and eighty-one adult patients with CHF and high e'/a' ratio (≥ 0.74) underwent repeat echocardiography 6 months after the initial examination, and were then followed up for a mean period of 20 months. After 6 months, e'/a' ratio did not change in 95 patients, whereas it was significantly decreased (<0.74) in the remaining 86 patients. During follow-up, 55 participants (30%) had cardiac events. According to multivariate Cox regression analysis, decrease in e'/a' ratio, initial New York Heart Association class III or IV, and change in LV mass index as well as in systolic mitral annular velocities emerged as independent predictors of survival. CONCLUSIONS: The decrease of an initially high e'/a' ratio on long-term therapy predicts a more favorable outcome in clinically stable patients with CHF.
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Lee et al. (2012) conducted a cohort in Chronic Heart Failure (n=181). Decrease in e'/a' ratio (<0.74) vs. Persistently high e'/a' ratio (≥0.74) was evaluated on Cardiac death or hospitalization for worsening heart failure (HR 0.327, 95% CI 0.180-0.595, p=<0.001). A decrease in an initially high e'/a' ratio after 6 months of therapy independently predicted a lower risk of cardiac events in patients with chronic heart failure (HR 0.327).
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