Left ventricular outflow tract velocity time integral in hospitalized heart failure with preserved ejection fraction

Abstract

Aims The prognostic implication of left ventricular outflow tract velocity time integral (LVOT‐VTI) on admission in hospitalized heart failure with preserved ejection fraction (HFpEF) patients has not been determined. We sought to investigate whether LVOT‐VTI on admission is associated with worse clinical outcomes in hospitalized patients with HFpEF. Methods and results We studied consecutive 214 hospitalized HFpEF patients who had accessible LVOT‐VTI data on admission, from a prospective HFpEF‐specific multicentre registry. The primary outcome of interest was the composite of all‐cause death and readmission due to heart failure. During a median follow‐up period of 688 (interquartile range 162–810) days, the primary outcome occurred in 83 patients (39%). The optimal cut‐off value of LVOT‐VTI for the primary outcome estimated by receiver operating characteristic analysis was 15.8 cm. Lower LVOT‐VTI was significantly associated with the primary outcome compared with higher LVOT‐VTI (P = 0.005). Multivariable Cox regression analyses revealed that lower LVOT‐VTI was an independent determinant of the primary outcome (hazard ratio 0.94, 95% confidence interval 0.91–0.98). In multivariable linear regression, haemoglobin level was the strongest independent determinant of LVOT‐VTI among clinical parameters (β coefficient = −0.61, P = 0.007). Furthermore, patients with lower LVOT‐VTI and anaemia had the worst clinical outcomes among the groups (P < 0.001). Conclusions Lower admission LVOT‐VTI was an independent determinant of worse clinical outcomes in hospitalized HFpEF patients, indicating that LVOT‐VTI on admission might be useful for categorizing a low‐flow HFpEF phenotype and risk stratification in hospitalized HFpEF patients.

A Practical Risk Score for Prediction of Early Readmission after a First Episode of Acute Heart Failure with Preserved Ejection Fraction

“…Our study identified some interesting correlations between echo-graphic findings and the likelihood of rehospitalization at six months for patients with acute HFpEF. Our finding that LVOT VTI is a determinant of HFR, with higher values predicting HFR, is in contrast with a recent study of Omote et al which associated a lower value with a worse outcome [ 26 ]. However, Omote et.al used a composite index (all-cause mortality and HFR) and followed the patients in the long-term.…”

Prevalence of the presystolic wave in echocardiography and its association with the extent of coronary artery disease in patients with chronic stable angina

“…In a study on 214 hospitalized heart failure patients with preserved ejection fraction, lower LVOT-VTI was related to the lower EF and higher incidence of adverse events. 18 One of the limitations of this study is the small sample size that effects the ability of the study to generalize its findings. The other limitation is heterogeneity of the EF subgroups affecting the statistical analysis.…”

“…Since, the PSW VTI, was not significantly related to EF, it can be hypothesized that LVOT VTI affected by the EF. In a study on 214 hospitalized heart failure patients with preserved ejection fraction, lower LVOT‐VTI was related to the lower EF and higher incidence of adverse events 18 …”

Assessing the Utility of End-Tidal Carbon Dioxide as a Marker for Fluid Responsiveness in Cardiogenic Shock

“…To measure cardiac output, velocity time integral (VTI) was measured via echocardiography (Aplio i-series, i600; Canon Medical Systems Corporation, Ōtawara, Japan) by calculating blood flow across the aortic valve. Left ventricular outflow tract (LVOT)‐VTI was obtained by placing a pulsed‐wave Doppler sample volume in the LVOT immediately proximal to the aortic valve in the anteriorly angulated apical four‐chamber view and tracing the outer boundaries of the peak spectral Doppler signal [ 15 ]. Continuous end-tidal CO 2 monitoring was obtained using Nihon Kohden CO 2 Sensor TG-900P JG-900P (Nihon Kohden Corporation, Tokyo, Japan).…”