Abstract 13992: The Clinical Significance of Diastolic Late Mitral Annular Velocity in Heart Failure With Preserved Left Ventricular Ejection Fraction
Background: Left atrial (LA) structure are altered in the majority of HF with preserved LVEF (HFpEF) patients. Because diastolic late mitral annular velocity (a’) measured by transthoracic echocardiography (TTE) is reported to represent the severity of LA remodeling, we investigated clinical significance of a’ in HFpEF.
Methods: We enrolled 422 consecutive HFpEF patients (sinus rhythm [SR]: n=337 [79.9%], atrial fibrillation [AF] rhythm: n=85 [20.1%]), admitted to Kumamoto University Hospital from 2006 to 2013, and performed TTE at stable condition after optimal therapy for HF. In patients with SR at the time of TTE, a’ values as an average of tissue Doppler velocities measured at septal and lateral mitral annuli. All HFpEF patients were followed until occurrence of cardiovascular events.
Results: In HFpEF patients with SR, a’ had a weak but significant negative correlations with B-type natriuretic peptide (BNP) (r=0.22, p<0.001), LA volume (r=0.28, p<0.001), the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity (E/e’) (r=0.24, p<0.001) and LV mass index (LVMI) (r=0.35, p<0.001). In multivariate logistic-regression analysis, E/e’ and LVMI were significantly and independently associated with decreased a’ (both, p<0.05). HFpEF patients with low-a’ (<8; median value of a’) had significantly higher BNP (p=0.01) and prevalence of hypertension (p<0.01), and lower prevalence of coronary artery disease (p=0.01) than those with high-a’ (≧8). In Kaplan-Meier analysis, HFpEF patients with AF had a significant higher risk of all cardiovascular and HF-related events than those with SR (both, log-lank test, p<0.01). Furthermore, HFpEF patients with low-a’ had a significant higher risk of cardiovascular events and HF-related events (both, log-lank test, p<0.01) than those with high-a’, and was prognostically equivalent to those with AF. Multivariate-Cox-hazard analysis identified that low-a’ as an independent predictor of both cardiovascular (hazard ratio [HR]: 0.87, 95% confidence interval [CI]: 0.76-0.99, p=0.04) and HF-related events (HR: 0.71, 95%CI: 0.57-0.88, p=0.002).
Conclusion: Estimation of a’ value is a non-invasive and useful method for risk stratification in patients with HFpEF.
Author Disclosures: F. Oike: None. E. Yamamoto: None. T. Tokitsu: None. Y. Hirata: None. S. Yamamura: None. Y. Izumiya: None. K. Kaikita: None. S. Hokimoto: None.
- © 2016 by American Heart Association, Inc.