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Prognostic Implications of Tissue Doppler Imaging–Derived E/Ea Ratio in Acute Heart Failure Patients
Author(s) -
Santas Enrique,
GarcíaBlas Sergio,
Miñana Gema,
Sanchis Juan,
Bodí Vicent,
Escribano David,
Muñoz Jaime,
Chorro Francisco J,
Núñez Julio
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12617
Subject(s) - medicine , interquartile range , cardiology , ejection fraction , heart failure , doppler imaging , proportional hazards model , bayesian multivariate linear regression , diastole , linear regression , blood pressure , machine learning , computer science
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.