Abstract 2245: A Combination of Systolic and Diastolic Function as a Powerful Predictor of Congestive Heart Failure at One Year Follow-up
Background: The early diastolic velocity of mitral annulus (E’) reflects the rate of myocardial relaxation. When combined with the measurement of the early transmitral flow velocity (E), the resultant ratio (E/E’) correlates well with mean left ventricular diastolic pressure. In particular, an E/E’>15 is an excellent predictor of adverse outcome in patients with congestive heart failure (CHF) and myocardial infarction. Ejection fraction (EF) is also known as a conventional predictor of CHF. This study was designed to determine a prognostic importance of a combined index, a novel predictor for CHF, E/E’ and a conventional predictor, EF in the clinical settings.
Method: A consecutive 91 patients who hospitalized with CHF underwent simultaneous clinical assessment, and comprehensive echo-Doppler study once ready for discharge. Patients were divided patients into 4 groups, group I (EF>40% and E/E’<15), group II (EF>40% and E/E’≥15), group III (EF≤40% and E/E’<15), and group IV (EF≤40% and E/E’ ≥ 15). The ability of this index to determine the primary end point (re-hospitalization for CHF or cardiac death) was assessed.
Results: Follow-up was complete on 86 of 91 patients at a mean of 348 days after hospital discharge. There were 20, 21, 18 and 27 patients (23, 24, 21 and 31%) in groups I, II, III and IV, respectively. There were 46 patients (53 %) with the primary end point (32 re-hospitalization and 14 cardiac deaths). On cox univariate analysis, EF<40%, E/E’ >15, group II and group IV were significant predictors of the primary end point. In multivariate cox proportional analysis, group IV and E/E’ >15 were independent predictors. In Kaplan-Meier analysis, event-free survival rate (78%) of group IV was significantly lower than those of other groups (group I, II and III, 13%, 67% and 44%, respectively).
Conclusions: A combined index, E/E’ and EF, is a strong predictor of re-hospitalization and cardiac death in patients with CHF at one-year follow-up. This easily available measurement adds significant value in the clinical management of CHF patients.