Abstract 2355: Absence of Significant Cardiac Abnormalities Detected by Portable Echocardiography Predict Excellent Survival in Patients With Suspected Heart Failure From the Community
Background: Portable echocardiography (PE) has been shown to be a valuable tool to rule out patients with significant cardiac abnormalities in patients with suspected heart failure (HF) referred from the community. However, to date there is no outcome data following PE in this group of patients.
Methods: Accordingly, 137 patients with suspected HF referred from the community for PE were followed up for death and hospitalisation for HF. Normal PE was defined as left ventricular ejection fraction (LVEF) >45% (normal systolic function), LAVI≤26ml/m2 (normal diastolic function) with no evidence of left ventricular (LV) hypertrophy (wall thickness<1.3cm) or significant valvular heart disease or right ventricular dysfunction.
Results: Of the 132 (mean age 71±13 years) patients followed up over a mean period of 26±7 months, 14 (11%) died and 5 (4%) were admitted to hospital with HF. Mortality was 4% when both LV systolic and diastolic function were normal (LVEF>45% and LAVI≤26ml/m2) but increased to 10% when only diastolic function was abnormal (LAVI>26ml/m2), increased further to 20% when there was only LV systolic dysfunction, increased further to 40% when both LV systolic and diastolic function were abnormal (p=0.0003). Similar trend (p<0.0001) was also noted for predicting combined end points of mortality or HF admission (table 1⇓). When PE was considered normal (n=63), mortality and mortality/HF admission were similar at 1.6% compared to 19% (p=0.003) and 26% (p=0.0002) respectively when PE was abnormal. Amongst other prognostic markers including clinical, electrocardiogram, and echocardiographic data, the combination of LVEF<45% or LAVI>26ml/m2 was the most powerful independent predictor of mortality (p=0.006).
Conclusion: Evaluation of diastolic dysfunction (LAVI) provided incremental information over LVEF for predicting outcome and absence of cardiac abnormalities predicts excellent survival in patients with suspected HF referred from the community.