J Cardiovasc Imaging.  2018 Dec;26(4):217-225. 10.4250/jcvi.2018.26.e22.

Pseudonormal or Restrictive Filling Pattern of Left Ventricle Predicts Poor Prognosis in Patients with Ischemic Heart Disease Presenting as Acute Heart Failure

• Lee JG
• Beom JW
• Choi JH
• Kim SY
• Kim KS
• Joo SJ

• KMID: 2429996
• DOI: http://doi.org/10.4250/jcvi.2018.26.e22

Abstract

BACKGROUND
In patients with acute heart failure (AHF), diastolic dysfunction, especially pseudonormal (PN) or restrictive filling pattern (RFP) of left ventricle (LV), is considered to be implicated in a poor prognosis. However, prognostic significance of diastolic dysfunction in patients with ischemic heart disease (IHD) has been rarely investigated in Korea.
METHODS
We enrolled 138 patients with IHD presenting as AHF and sinus rhythm during echocardiographic study. Diastolic dysfunction of LV was graded as ≥ 2 (group 1) or 1 (group 2) according to usual algorithm using E/A ratio and deceleration time of mitral inflow, E"²/A"² ratio of tissue Doppler echocardiography and left atrial size.
RESULTS
Patients in group 1 showed higher 2-year mortality rate (36.2% ± 6.7%) than those in group 2 (13.6% ± 4.5%; p = 0.008). Two-year mortality rate of patient with LV ejection fraction (LVEF) < 40% (26.8% ± 6.0%) was not different from those with LVEF 40%-49% (28.0% ± 8.0%) or ≥ 50% (13.7% ± 7.4%; p = 0.442). On univariate analysis, PN or RFP of LV, higher stage of chronic kidney disease (CKD) and higher New York Heart Association (NYHA) functional class were poor prognostic factors, but LVEF or older age ≥ 75 years did not predict 2-year mortality. On multivariate analysis, PN or RFP of LV (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.09-5.84; p = 0.031), higher stage of CKD (HR, 1.57; 95% CI, 1.14-2.17; p = 0.006) and higher NYHA functional class (HR, 1.81; 95% CI, 1.11-2.94; p = 0.017) were still significant prognostic factors for 2-year mortality.
CONCLUSIONS
PN or RFP of LV was a more useful prognostic factor for long-term mortality than LVEF in patients with IHD presenting as AHF.

Keyword

Heart failure; Dysfunctions; Left ventricle; Ischemic heart disease

MeSH Terms

Deceleration
Echocardiography
Echocardiography, Doppler
Heart Failure*
Heart Ventricles*
Heart*
Humans
Korea
Mortality
Multivariate Analysis
Myocardial Ischemia*
Prognosis*
Renal Insufficiency, Chronic

Figure

• 

  Figure 1 Kaplan-Meier 2-year survival curves for the pseudonormal (PN) or restrictive filling pattern (RFP) of left ventricle (LV) and LV ejection fraction.

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