Abstract 18911: Prognosis of Latent Systolic Dysfunction in Patients Referred for Stress Echocardiography With Normal LV Ejection Fraction
Background: Tissue Doppler imaging can assess latent systolic function. The prognostic impact of latent systolic dysfunction in patients with normal ejection fraction is limited.
Methods: We measured the left ventricular septal S wave velocity (Sm) at rest in 908 patients, mean age 58 ±14 years, 40% males who were referred for stress echocardiography with normal left ventricular ejection fraction (>55%).
Results: There were 42 (5%) deaths during the mean follow-up of 3.1 ± 0.6 years. Only 44 (6%) had ischemia on stress echocardiogram. There were significant high correlations observed between age and Sm and E′ (r= -0.24; p<0.001 and r= -0.53; p<0.001, respectively) and very high correlations were observed between Sm and E′ (r =0.51; p<0.001). After adjusting for age, gender, CAD risk factors, and ischemia, and interaction of age*Sm, higher age (HR=1.01; 95% CI: 1.004 - 1.01; p<0.001) with normal S wave velocity, and higher S wave velocity (HR = 0.51; 95% CI: 0.36 - 0.73; p<0.001) independent of age were the predictors of mortality. Similarly, diastolic dysfunction was a predictor of mortality (HR= 0.56; 95% CI = 0.41 - 0.76; p<0.001). [FIGURE] However, addition of Sm in the model after E′ or addition of E′ after Sm does not affect the model. On sub-group analyses, taking only patients with diastolic dysfunction same results were observed. Lower Sm and E′ septal both were predictors of worse outcomes but dependent on each other.
Conclusion: Latent systolic dysfunction and diastolic dysfunction are highly correlated and associated with worse outcomes in patients with normal ejection fraction. Further studies with large cohort and longer follow-up are needed to determine whether these basic indices can prognosticate this cohort.
- © 2013 by American Heart Association, Inc.