The prognostic value of a new tissue Doppler parameter in patients with heart failure

It has been shown a good accuracy to predict high left ventricular end-diastolic pressure for a value >1.6 of a new tissue Doppler index, E/(E′ × S′), including the ratio between early diastolic transmitral and mitral annulus velocity (E/E′), and the systolic mitral annulus velocity (S′). Our aim was to evaluate the prognostic value of E/(E′ × S′) > 1.6 in patients with heart failure (HF). Echocardiography was performed in 345 consecutive hospitalized patients with HF, in sinus rhythm, at hospital discharge and after 1 month. Worsening of E/(E′ × S′) was defined as any increase of baseline value. The primary end point consisted of cardiac death or readmission due to HF worsening in long term follow-up. At discharge, 153 patients (44.3 %) presented E/(E′ × S′) ≤ 1.6 (group I) while 192 patients (55.7 %) presented E/(E′ × S′) > 1.6 (group II). During the follow-up period (35.1 ± 8.7 months) the first cardiac event was cardiac death in 11 patients (3.1 %) and readmission for HF in 179 patients (51.9 %). The composite end point was significantly higher in group II than in group I (163 events, 84.9 % vs. 27 events, 17.6 %, p < 0.001). By multivariate Cox regression analysis, E/(E′ × S′) > 1.6 was the best independent predictor of cardiac events (hazard ratio = 4.46, 95 % CI = 2.44–8.13, p = 0.001). Patients with E/(E′ × S′) > 1.6 at discharge and its worsening after 1 month have presented the worst prognosis (all p < 0.05). In patients with HF, E/(E′ × S′) > 1.6 at hospital discharge is a powerful predictor of clinical outcome particularly if it is associated with worsening.