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  • Title: Different prognostic impact of the tissue Doppler-derived E/e' ratio on mortality in Chagas cardiomyopathy patients with heart failure.
    Author: Nunes MP, Colosimo EA, Reis RC, Barbosa MM, da Silva JL, Barbosa F, Botoni FA, Ribeiro AL, Rocha MO.
    Journal: J Heart Lung Transplant; 2012 Jun; 31(6):634-41. PubMed ID: 22305956.
    Abstract:
    BACKGROUND: Risk assessment of Chagas cardiomyopathy patients is essential for clinical decision making. The ratio of the ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/e') is a powerful predictor of adverse outcome in patients with heart failure. However, its prognostic value remains to be established in the setting of Chagas cardiomyopathy. This study investigated the effect of E/e' on mortality according to different degrees of left ventricular (LV) systolic function in patients with Chagas cardiomyopathy. METHODS: The study prospectively enrolled 232 patients (143 men) with Chagas cardiomyopathy (mean age, 48 ± 12 years). End points were death or cardiac transplantation. RESULTS: During a mean follow-up of 3.4 years, 107 patients had an adverse cardiac event, with an overall events rate of 13.2/year. Cox proportional hazards model was used with New York Heart Association functional class, LV ejection fraction, right ventricular function, indexed left atrial volume, E/e' ratio, and the statistical interaction term between E/e' ratio and LV ejection fraction. The effect of E/e' ratio on mortality depended on the degree of LV systolic dysfunction. An increasing E/e' ratio was a strong predictor of outcome in patients with mild to moderate LV dysfunction but was inversely associated with mortality in patients with severe systolic dysfunction. CONCLUSION: This study demonstrated the role of the interaction between LV ejection fraction and E/e' ratio in predicting prognosis in Chagas cardiomyopathy patients. The E/e' ratio had a stronger prognostic value in patients with mild and moderate LV dysfunction and was inversely associated with mortality in patients with advanced systolic heart failure.
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