Abstract 4199: Combining E/e′ and Indexed Left Atrial Volume Augments Clinical Prediction of First Heart Failure in Elderly
While tissue Doppler imaging (TDI) - derived index, E/e′, has been shown to correlate well with left ventricular (LV) filling pressure, its predictive value for incident heart failure (HF) has not been defined. This prospective cohort study included persons who were of age ≥65 years, in sinus rhythm, and were referred for an echocardiogram. Exclusion criteria included a history of HF, atrial arrhythmia, and valvular heart disease. Clinical data were obtained by brief interview at the time of echocardiographic study and from medical record review. E/e′ referred to the ratio of pulsed wave Doppler assessment of mitral early diastolic filling velocity (peak E) to TDI assessment of septal mitral annular motion peak early velocity during diastole (e′). Left atrial (LA) volume was assessed using the biplane area-length method. Diastolic function was graded by standard Doppler assessment of mitral inflow and pulmonary venous flow. Participants were followed for the development of first HF, defined as per Framingham criteria. Cox proportional hazards modeling was used for assessment of E/e′ for prediction of first HF. Receiver operator characteristic (ROC) method was used for sensitivity and specificity analyses of predictors, and the survival version of the C-statistic used to compare models. Of the 917 patients (53% men), age 73 ± 6 years, followed for a mean of 3.5 ± 2.4 years, 36 (4%) developed first HF. E/e′ was independently predictive of first HF (Table⇓). The C-statistic for the multivariable model with both indexed LA volume and E/e′ was 0.76 (versus 0.70 when E/e′ was not included in the model). ROC area under the curves was 0.71 for E/e′ and 0.68 for indexed LA volume. Sensitivity and specificity for first HF prediction were 54% and 83% for E/e′>14, and 85% and 28% for indexed LA volume >32mL/m 2.
This research has received full or partial funding support from the American Heart Association, Midwest Affilate (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota & Wisconsin).