Abstract 13440: Presystolic Waves in the Outflow Tract: Clinical Significance in Reduced Ejection Fraction
Background: A presystolic wave (PSW) is common on Doppler examination of the aortic outflow tract (figure). Little is known of its clinical significance.
Methods: Clinically ordered echocardiograms of patients in sinus rhythm were reviewed; 100 with EF <45% were randomly selected. Presence or absence of PSW was noted along with its peak velocity. Mitral flow velocity (E and A waves), tissue Doppler velocity at the septal annulus (e’ and a’), demographic, and clinical variables were recorded. We tested the hypotheses that PSW would correlate with measures of atrial contraction (A, a’) and with measures of poor LV diastolic function (lower e’, higher E/e’)and predict adverse outcomes.
Results: PSW was present in 62%. In those with PSW, a’ was greater than in those without. There were no significant differences for E, A, or e’, though e’/a’ was lower when PSW was present (table).
PSW correlated with age (rho=0.30, p=0.0004) but not gender or BMI. Among Doppler variables, PSW showed a moderate correlation with a’ (rho=0.38, p=0.002); this remained significant after adjusting for age (p=0.01). Patients were followed for a mean of 1.7 ± 0.3 years. MACE (death, CHF, AFIB, CVA) occurred in 32% when PSW was present vs 53% when not, p=0.04. After adjusting for multiple clinical factors and left atrial volume index, PSW remained predictive of MACE (p=0.048).
Conclusions: In patients with reduced EF, appearance of PSW appears to be related to more forceful atrial contraction. Its presence is associated with fewer adverse outcomes.
- © 2013 by American Heart Association, Inc.