Author + information
- Received October 23, 1995
- Revision received March 27, 1996
- Accepted April 9, 1996
- Published online August 1, 1996.
- Pantaleo Giannuzzi, MD*,
- Pier L. Temporelli, MD,
- Enzo Bosimini, MD,
- Pedro Silva, MD,
- Alessandro Imparato, MD,
- Ugo Corrà, MD,
- Michele Galli, MD and
- Amerigo Giordano, MD
- ↵*Address for correspondence: Dr. Pantaleo Giannuzzi, Centro Medico di Riabilitazione, Divisione di Cardiologia, 28010 Veruno (NO), Italy.
Objectives. This study sought to investigate the relative and incremental prognostic value of demographic, historical, clinical, echocardiographic and mitral Doppler variables in patients with left ventricular systolic dysfunction.
Background. The prognostic value of diastolic abnormalities as assessed by mitral Doppler echocardiography has yet to be defined.
Method. A total of 508 patients with left ventricular ejection fraction ≤35% were followed up for a mean (±SD) period of 29 ± 11 months.
Results. During the follow-up period, 148 patients (29.1%) were admitted to the hospital for congestive heart failure, and 100 patients (19.7%) died. By Cox model analysis, Doppler-derived mitral deceleration time of early filling ≤125 ms (relative risk [RR] 1.93, 95% confidence interval [CI] 1.4 to 3.7), New York Heart Association functional class III or IV (RR 1.49, 95% CI 1.4 to 2.3), ejection fraction ≤25% (RR 1.85, 95% CI 1.6 to 2.9), third heart sound (RR 2.06, 95% CI 1.8 to 3.2), age >60 years (RR 1.95, 95% CI 1.8 to 3.1) and left atrial area >18 cm2 (RR 1.73, 95% CI 1.6 to 2.7) were all found to be independent and additional predictors of all-cause mortality, and deceleration time was the single best predictor (chi-square 37.80). When all these significant variables were analyzed in hierarchic order, after age, functional class, third sound, ejection fraction and left atrial area, deceleration time still added significant prognostic information (global chi-square from 9.2 to 104.7). Also, deceleration time was the strongest independent predictor of hospital admission for congestive heart failure (RR 4.88, 95% CI 3.7 to 6.9) and cumulative events (congestive heart failure or all-cause mortality, or both; RR 2.44, 95% CI 2.0 to 3.8) in both symptomatic and asymptomatic patients.
Conclusions. Deceleration time of early filling is a powerful independent predictor of poor prognosis in patients with left ventricular systolic dysfunction, whether symptomatic or asymptomatic. A short (≤125 ms) deceleration time by mitral Doppler echocardiography adds important prognostic information compared with other clinical, functional and echocardiographic variables.
This study was supported in part by Grant Ricerca Corrente 1993/94 from the Ministero della Sanità, Rome, Italy, and was presented at the 67th Annual Scientific Sessions of the American Heart Association, Dallas, Texas, November 1994.
- Received October 23, 1995.
- Revision received March 27, 1996.
- Accepted April 9, 1996.
- American College of Cardiology