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Prognostic importance of a short deceleration time in symptomatic congestive heart failure ☆
Author(s) -
Akkan Dilek,
Kjærgaard Jesper,
Møller Jacob Eifer,
Hassager Christian,
TorpPedersen Christian,
Køber Lars
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.05.007
Subject(s) - medicine , cardiology , heart failure , hazard ratio , ejection fraction , confidence interval , population , proportional hazards model , environmental health
Aims: A restrictive transmitral filling (RF) pattern predicts increased mortality in heart failure (HF) with reduced left ventricular (LV) systolic function. We performed a combined evaluation of LV function and RF for prognosis in patients with HF with and without systolic dysfunction. Methods and results: Doppler echocardiography was performed in 972 patients with symptomatic HF. RF was considered present when deceleration time (DT) was ≤140 ms and non‐RF when > 140 ms. A DT >240 ms was defined as delayed relaxation. During a median of 51 months the unadjusted all‐cause mortality rates were significantly increased among patients with RF vs. the non‐RF group (1‐ and 4‐year mortality was 25% and 54% vs. 17% and 43%). In a multivariable model, RF was a significant predictor of all‐cause mortality (hazard ratio (HR)=2.0, 95% confidence interval (CI):1.5–2.6) whereas delayed relaxation was without prognostic importance (HR=0.9, CI:0.5–1.6). Repeating the multivariable model in subgroups of wall motion index (WMI) showed that RF was a strong predictor of mortality independent of WMI. For patients with LVEF of at least 50%, HR for RF was 2.0 (CI:1.1–3.4; p =0.02) and interaction between LVEF and RF was not significant. Conclusion: In a heterogeneous population hospitalised for symptomatic HF a restrictive transmitral filling pattern, defined as shortened deceleration time, during hospitalisation is an ominous prognostic sign independent of LV systolic function.