Usefulness of Mitral Inflow Velocity and Mitral Annulus Velocity for Predicting Long-term Prognosis in Heart Failure with Restrictive Filling Pattern

Bae, Jang Whan; Kang, Hyun Jae; Kim, Kwang Il; Kim, Yong Jin; Sohn, Dae Won; Oh, Byung Hee; Lee, Myoung Mook; Park, Young Bae; Choi, Yun Shik

Abstract

BACKGROUND AND OBJECTIVES
The restrictive filling pattern (RFP) is accepted as a poor prognostic marker in congestive heart failure (CHF) patients. But, recently the RFP has been categorized into various prognosis subgroups by their clinical signs or echocardiographic markers with loading manipulation. But, in critically ill or severe dyspneic patients these loading manipulations are not practical to apply. Therefore, we tried to establish simple, reliable prognostic echocardiographic variables in CHF patients with the RFP. MATERIALS AND METHOD: 40 patients with the RFP were observed for 35+/-19 months after echocardiographic examination. We obtained baseline peak early (E), late (A) mitral inflow velocities, E/A ratio, deceleration time of E velocity (DT), peak early (E'), late (A') diastolic mitral annulus velocities, E'/A' ratio, reversibility of the RFP. The reversibility of RFP was defined as E/A ratio reverse (<1) during the Valsalva's maneuver. With the clinical and survival data during follow up period, we established significant prognostic variables in these patients.
RESULTS
In univariate analysis, low systolic blood pressure (p=0.013), low A velocity (p=0.044), low A' velocity (p=0.028) and the irreversibility of RFP (p=0.024) were significant drastic prognosis variables. Especially, patients with A velocity <0.32 m/sec or A' velocity <0.04 m/sec showed significantly higher mortality.
CONCLUSION
In CHF patients with the RFP, A velocity and A' velocity are very practical prognostic echocardiographic variables and patients with the low A velocity (<0.32 m/sec) or the low A' velocity (<0.04 m/sec) showed higher mortality rate.