P439 Prognostic Value of new Doppler Echocardiographic Parameters- Implications for Risk Stratification in Patients with Chronic Congestive Heart Failure.
T.Acil, Chr.Bruch, J.Stypmann, G.Breithardt, T.Wichter
Universität Münster, Med. Klinik und Poliklinik C, Münster.

Background: Echocardiographic indices have already been used to predict outcome in patients (pts.) with congestive heart failure (CHF). However, systolic and diastolic mitral annular velocities (S, E, A) derived from by tissue Doppler imaging (TDI), the mitral E/E-ratio and assessment of the Tei-Index (isovolumic contraction time and isovolumic relaxation time dived by ejection time) may add incremental value.

Methods& Results: One hundred thirty-three subjects with an ejection fraction (EF) < 45% and a history of CHF (attributable to ischemic (n=83) or dilated (n=47) cardiomyopathy or valvular heart disease (n=3)) underwent assessment of standard chamber dimensions and volumes, mitral inflow velocities, deceleration time (DT) and Tei-Index. S, E and A were derived from pulsed TDI. Study subjects were followed for 10±4 months. The end point was a cardiac event defined as cardiac death or hospital re-admission for CHF. During follow-up, 6 pts. (4.5%) died and 20 pts. (15%) were re-hospitalized for CHF.

*p<0.05, **p <0.01, #p<0.001 vs. event-free.
Group Age (years) EF (%) Mitral E/A-ratio S' (cm/s) E' (cm/s) A' (cm/s) E/E' DT (ms) Tei-Index
Event-free (n=107) 57±11 32±9 1.45±1.03 5.3±1.0 6.5±1.7 7.6±2.2 10.6±5.0 191±72 0.88±0.27
Event (n=26) 59±13 27±11* 2.86 ±1.22# 4.4±0.9# 5.5±1.4** 6.2±2.7* 17.0±6.7# 136±52# 1.10 ±0.42**

Univariate variables, that predicted cardiac events, included mitral E/A-ratio, S, E, mitral E/E-ratio, DT and Tei-Index. However, in the multivariate (stepwise backward) analysis the strongest predictor for a cardiac event was the mitral E/E-ratio (hazard ratio 1.287, 95% confidence interval 1.037-1.597).

Conclusion: S and E derived from TDI and the Tei-Index add incremental prognostic value in subjects with chronic CHF. However, in such pts. the most promising parameter for prediction of cardiac events is mitral E/E-ratio.