Abstract 3181: Diagnostic Usefulness and Prognostic Impact of Tissue Doppler Imaging in Heart Failure Patients with Significant Secondary Mitral Regurgitation
Background/Aim: In patients (pts) with chronic heart failure (CHF), the presence of significant secondary mitral regurgitation (MR) is associated with increased morbidity and mortality. In such pts, the diagnostic usefulness and prognostic impact of tissue Doppler imaging (TDI) has not been studied.
Methods: This prospective study enrolled 370 pts with stable CHF (mean age 59±13 years, mean New York Heart Association (NYHA) functional class 2.6±0.5, mean ejection fraction (EF) 31±10%). Significant secondary MR defined as effective regurgitant orifice area ≥ 0.20 cm2 was present in 92 patients (25%). Echo measurements comprised left ventricular dimensions/volumes, EF, mitral E/A-ratio, deceleration time and TDI derived mitral annular velocities (S’, E’, A’, E/E’). During a follow-up of 790±450 days, all-cause mortality and re-hospitalization data were analyzed.
Results: Pts with or without significant MR did not differ with respect to age, medication, EF or mitral annular E’ velocity, but MR pts were in a poorer NYHA functional class (2.8±0.4 vs. 2.6±0.5, p=0.01) and had a higher mitral E/E’ ratio (15.5±9.7 vs. 12.5±6.1, p=0.001). During follow-up, 70 patients (18%) died and 134 patients (36%) were re-hospitalized due to worsening CHF. Mortality was significantly higher in patients with vs. without MR (33% vs. 14%, Chi square: 15.5, p=0.001). In the MR group, mortality was independently predicted by the mitral E/E’ ratio (HR: 1.06, 95% CI 1.009 –1.111, p=0.021) and age (HR: 1.043, 95% CI 1.01–1.077, p=0.011). In MR pts with an E/E’ ratio > 13.5 (cut-off value derived from ROC analysis, area under the ROC curve: 0.68±0.05), outcome was markedly worse in comparison to pts with an E/E’ ratio < 13.5 (event-free survival rate 31% vs. 64%, p<0.001). In the MR group, the E/E’ ratio was the only clinical and echocardiographic variable with a significant association with re-hospitalization due to worsening CHF (HR: 1.04, 95% CI 1.005–1.081, p=0.026).
Conclusions: In CHF pts with significant secondary MR, a higher E/E’ ratio is associated with increased morbidity and an adverse outcome. TDI may be a useful adjunct in the diagnostic work-up and risk stratification of such patients.