Abstract 360: Comparative Effectiveness of 15 Echocardiographic Indices for Prediction of First Heart Failure in Subjects With Normal Left Ventricular Systolic Function
Background: Little is known regarding how different echocardiographic predictors of heart failure (HF) compare.
Methods: This prospective cohort study included subjects aged ≥ 65 years and recruited to the study in 2001–2002 when presented for clinical appointments at Mayo Clinic. All had to have no history/evidence of atrial fibrillation (AF), HF, stroke, valvular or congenital heart disease, or pacemaker implantation. At enrollment, echocardiogram was performed. Subjects with abnormal left ventricular (LV) ejection fraction were excluded from analyses. Participants were followed clinically and via mailed survey. The following echocardiographic paramaters were evaluated:
indexed maximal left atrial volume (LAV);
indexed minimal LAV;
total LA emptying fraction (EF) [maximal-minimal LAV]/maximal LAV;
passive LAEF [max-pre-A LAV/maximal LAV],
active LA EF [preA-min LAV/preA LAV],
Doppler peak E velocity,
Doppler peak mitral A velocity,
mitral deceleration time,
mitral E:A ratio,
mitral A time velocity integral (TVI),
mitral A TVI/total A and E TVI,
tissue Doppler e′,
tissue Doppler a′;
tissue Doppler E/e′.
Results: Of 523 persons (mean age 73±6 years), 30 (6%) developed new onset of HF over a mean follow up of 4.6±2 years. The following variables were predictive of first HF on univariable analyses: indexed maximal LAV, indexed minimal LAV, total LAEF, tissue Doppler e′ and E/e′. All these variables were incremental to baseline clinical model (age, sex, hypertension, diabetes, myocardial infarction, body mass index) for prediction, except for total LAEF which showed only a trend to significance. The model which provided the best predictive power included clinical risk factors, indexed LA volume and E/e′ (Table⇓).
Conclusion: This comparative effectiveness study showed that LA size and LV filling pressure assessment contribute significantly to risk stratification of HF in subjects with normal LV ejection fraction.