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  • Title: Ratio of transmitral early filling velocity to early diastolic strain rate predicts outcomes in patients with systolic heart failure.
    Author: Chan YH, Lee HF, Wu LS, Wang CL, Wu CT, Yeh YH, Ho YW, Hsu LA, Chu PH, Kuo CT.
    Journal: Eur Heart J Cardiovasc Imaging; 2017 Jan; 18(1):79-85. PubMed ID: 26896414.
    Abstract:
    AIMS: The ratio of transmitral early filling velocity (E) to early diastolic tissue velocity (E') is a key diastolic function parameter. The early diastolic strain rate (E'sr) has been proposed as a substitute for E' in the E/E' ratio for better estimation of left ventricular (LV) filling pressure. This study aims to assess the predictive value of combined E/E'sr ratio and global longitudinal strain (GLS) for prognosis in systolic heart failure (SHF). METHODS AND RESULTS: We retrospectively analysed 330 SHF patients with an LV ejection fraction (LVEF) ≤ 40%. Study end points were defined as all-cause mortality or heart transplantation. The incremental value of GLS and the E/E'sr ratio over LVEF and E/E' for outcome prediction was assessed using nested Cox models. Ninety-nine (30%) patients reached the end point over a median follow-up of 46 months. Baseline variables associated with outcomes were age, glomerular filtration rate, pulmonary artery systolic pressure, and LV end-systolic volume index. After multivariate adjustment, GLS (hazard ratio: 1.48, P = 0.025) and the E/E'sr ratio (hazard ratio: 1.41, P = 0.002) were both independent predictors. LVEF or E/E' was not an independent predictor when GLS and E/E'sr were included in the model. Patients with impaired GLS (absolute value <7.5%) and elevated E/E'sr ratios (E/E'sr ≥ 195 cm) showed poor outcomes. CONCLUSION: The E/E'sr ratio is stronger than E/E' ratio in predicting prognosis of patients with systolic HF. Combined assessments of GLS and E/E'sr by speckle-tracking longitudinal strain facilitate risk stratification of these patients.
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