Prognostic Implications of Tissue Doppler Imaging-Derived E/Ea Ratio in Acute Heart Failure Patients.

ALDOSTERONE antagonists; ANALYSIS of variance; ACE inhibitors; ANTICOAGULANTS; BLOOD flow measurement; BLOOD pressure; CARDIOVASCULAR system physiology; CHI-squared test; CONFIDENCE intervals; DOPPLER echocardiography; LEFT heart ventricle; HEART failure; HEMODYNAMICS; LONGITUDINAL method; PROBABILITY theory; PROGNOSIS; REGRESSION analysis; VITAL signs; DATA analysis software; ANGIOTENSIN receptors; HOSPITAL mortality; KAPLAN-Meier estimator; OLD age

Background Tissue Doppler-derived transmitral to mitral annular early diastolic velocity ratio (E/Ea), as a noninvasive estimation of left ventricular ( LV) filling pressures, is a strong prognosticator in various cardiac scenarios including chronic heart failure; nevertheless, its utility for risk stratification in the whole spectrum of acute heart failure ( AHF) patients remains elusive. Thus, the aim of this study was to determine the association between E/Ea ratio and 1-year mortality in nonselected patients with AHF. Methods The study included 417 consecutive patients admitted for AHF. Twenty-two patients were excluded due to nonaccurate Ea measurements, leaving the final sample to be 395 patients. E-wave, septal, and lateral Ea velocities were measured following initial stabilization and according to current recommendations. The association of mean E/Ea ratio with all-cause mortality was assessed using Cox regression analysis. Results At a median follow-up of 306 days (interquartile range, 118-564), 89 deaths (22.5%) were registered. Mean age and E/Ea ratio were 72 ± 11.5 and 20 ± 3. Proportion of LV ejection fraction ≥50% was 47%. In multivariate analysis, after adjusting for well-known prognostic factors, including natriuretic peptides, E/Ea ratio was linearly associated with an increase risk of all-cause mortality ( HR 1.04, 95% CI 1.03-1.05; P < 0.001, per increase in one unit of E/Ea). The threshold of risk was identified above 20. No significant interactions among the most important subgroups were found. Conclusion In AHF patients, tissue Doppler imaging derived E/Ea ratio is independently associated with an increased risk of all-cause mortality. [ABSTRACT FROM AUTHOR]