Author + information
- Jacob Colin Jentzer,
- Sunil Mankad,
- Sorin Pislaru,
- Gregory Barsness,
- Kianoush Kashani,
- Alejandro Rabinstein and
- Roger White
Background: The association between diastolic dysfunction on echocardiogram and mortality has not been systematically explored in patients resuscitated from out-of-hospital cardiac arrest (OHCA).
Methods: We retrospectively reviewed 190 patients receiving therapeutic hypothermia at Mayo Clinic St. Mary's Hospital after cardiac arrest between December 2005 and March 2014. We included 109 patients who had an early diastolic mitral inflow spectral Doppler (E) velocity to early diastolic medial mitral annular tissue Doppler (e') velocity ratio (E/e’ ratio) calculated on transthoracic echocardiogram during hospitalization. We evaluated the association of E/e’ ratio with inpatient mortality using receiver-operator curve analysis followed by multivariate analysis using JMP version 10. Means were compared using two-tailed t-test at p <0.05.
Results: Mean age was 61±12 years and 70% were male. Rhythm was shockable in 90% and 36% had ST-elevation myocardial infarction (STEMI); 39% underwent percutaneous coronary intervention. Mean left ventricular ejection fraction (LVEF) was 40±18%. Patients who died in the hospital (n = 27, 25%) had similar E velocity (72±32 vs. 61±23 cm/s, p > 0.1), lower e’ velocity (4.7±2.3 vs. 5.7±2.5 cm/s, p < 0.05) and higher medial E/e’ ratio (17.6±9.8 vs. 12.1±5.8, p < 0.01) compared to hospital survivors. E/e’ ratio predicted inpatient mortality (area under the curve = 0.697, p < 0.01), with an optimal cut-off of 13.3. E/e’ ratio >13 was present in 41 patients (37.6%), with an odds ratio of 5.13 for inpatient death (67% vs. 28%, p < 0.001). E/e’ ratio predicted overall mortality during 3.1±3.0 years of follow-up (area under the curve = 0.760, p <0.001), and medial E/e’ ratio >13 had an odds ratio of 9.11 for overall mortality (p <0.001). E/e’ ratio predicted inpatient (unit odds ratio = 1.16, p < 0.01) and overall (unit odds ratio = 1.23, p <0.001) mortality after multivariate adjustment for age, shockable rhythm, witnessed arrest, STEMI, inpatient coronary angiogram and LVEF.
Conclusions: Diastolic dysfunction, defined by a higher Doppler medial E/e’ ratio on echocardiogram, is a novel independent predictor of inpatient and long-term mortality after cardiac arrest.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Insights From Echocardiography Use
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1291-225
- 2017 American College of Cardiology Foundation