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Incremental prognostic value of echocardiography of left ventricular remodeling and diastolic function in STICH trial.

Abstract：

AIMS:We sought to determine which echocardiographic markers of left ventricular (LV) remodeling and diastolic dysfunction can contribute as incremental and independent prognostic information in addition to current clinical risk markers of ischemic LV systolic dysfunction in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. METHODS AND RESULTS:The cohort consisted of 1511 of 2136 patients in STICH for whom baseline transmitral Doppler (E/A ratio) could be measured by an echocardiographic core laboratory blinded to treatment and outcomes, and prognostic value of echocardiographic variables was determined by a Cox regression model. E/A ratio was the most significant predictor of mortality amongst diastolic variables with lowest mortality for E/A closest 0.8, although mortality was consistently low for E/A 0.6 to 1.0. Mortality increased for E/A < 0.6 and > 1.0 up to approximately 2.3, beyond which there was no further increase in risk. Larger LV end-systolic volume index (LVESVI) and E/A < 0.6 and > 1.0 had incremental negative effects on mortality when added to a clinical multivariable model, where creatinine, LVESVI, age, and E/A ratio accounted for 74% of the prognostic information for predicting risk. LVESVI and E/A ratio were stronger predictors of prognosis than New York Heart Association functional class, anemia, diabetes, history of atrial fibrillation, and stroke. CONCLUSIONS:Echocardiographic markers of advanced LV remodeling and diastolic dysfunction added incremental prognostic value to current clinical risk markers. LVESVI and E/A ratio outperformed other markers and should be considered as standard in assessing risks in ischemic heart failure. E/A closest to 0.8 was the most optimal filling pattern.

journal_name

Cardiovasc Ultrasound

journal_title

Cardiovascular ultrasound

authors

Kim KH,She L,Lee KL,Dabrowski R,Grayburn PA,Rajda M,Prior DL,Desvigne-Nickens P,Zoghbi WA,Senni M,Stefanelli G,Beghi C,Huynh T,Velazquez EJ,Oh JK,Lin G

doi

10.1186/s12947-020-00195-1

subject

Has Abstract

pub_date

2020-05-28 00:00:00

pages

issue

issn

1476-7120

pii

10.1186/s12947-020-00195-1

journal_volume

pub_type

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Incremental prognostic value of echocardiography of left ventricular remodeling and diastolic function in STICH trial.