Prognostic value of left ventricular mitral annular longitudinal displacement obtained by tissue Doppler imaging in patients with heart failure with reduced ejection fraction

Figures

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  Figure 1. Measurement of mitral longitudinal displacement by tissue Doppler imaging. Regional LD is obtained in the apical four-chamber view by placing a sample volume in the septal and lateral annular sites. LD is then measured by tracking the tissue from the start of the systolic ejection period to the aortic valve closure. These steps are then repeated for the two-chamber and three-chamber in the remaining four annular sites (anterior, posterior, anterior septal and inferior). The measurement is expressed in millimetres. LD, longitudinal displacement.

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  Figure 2. Kaplan-Meier curves for patients stratified into tertiles of LD. Depicting cumulative survival for the patient population stratified into tertiles of LD. LD, longitudinal displacement.

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  Figure 3. Regional LD and prognosis. (A) Regional LD (mean±SD) for patients alive or dead at follow-up, and univariable HRs describing the risk of mortality per 1 mm decrease in LD for each myocardial wall. (B) HR per 1 mm decrease in LD obtained from each myocardial wall. The multivariable model includes age, gender, ischaemic origin, BMI, diabetes, MAP, AF, PM, heart rate, LVIDd, LVEF, LVMI, LAVI, E velocity, E’, E/e’, TAPSE and DT. (C) HR per 1 mm decrease in LD obtained from each myocardial wall. The multivariable model includes age, gender, ischaemic origin, BMI, diabetes, MAP, AF, heart rate, LVIDd, LVEF, LVMI, LAVI, E velocity, TAPSE, DT and GLS. AF, atrial fibrillation; BMI, body mass index; DT, deceleration time; E, peak transmitral early diastolic inflow velocity; e’, average peak early diastolic mitral annular velocity; GLS, global longitudinal strain; LAVI, left atrial volume index; LD, longitudinal displacement, LVEF, left ventricular ejection fraction; LVIDd, left ventricular internal dimension in diastole; LVMI, left ventricular mass index; PM, pacemaker; TAPSE, tricuspid annular plane systolic excursion.

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  Figure 4. Incidence rates of mortality based on LD obtained from each myocardial wall. (A) Association between anterior septal LD and mortality. The incident of death per 100 patient-years is depicted on the y-axis and LD in millimetre on the x-axis. The graph is superimposed on a histogram of anterior septal LD of the HFrEF cohort. (B) Association between septal LD and mortality. The incident of death per 100 patient-years is depicted on the y-axis and LD in millimetre on the x-axis. The graph is superimposed on a histogram of septal LD of the HFrEF cohort. (C) Association between anterior LD and mortality. The incident of death per 100 patient-years is depicted on the y-axis and LD in millimetre on the x-axis. The graph is superimposed on a histogram of anterior LD of the HFrEF cohort. (D) Association between posterior LD and mortality. The incident of death per 100 patient-years is depicted on the y-axis and LD in millimetre on the x-axis. The graph is superimposed on a histogram of posterior LD of the HFrEF cohort. (E) Association between lateral LD and mortality. The incident of death per 100 patient-years is depicted on the y-axis and LD in millimetre on the x-axis. The graph is…