Prognostic importance of a short deceleration time in symptomatic congestive heart failure☆

Abstract

Aims: A restrictive transmitral filling (RF) pattern predicts increased mortality in heart failure (HF) with reduced left ventricular (LV) systolic function. We performed a combined evaluation of LV function and RF for prognosis in patients with HF with and without systolic dysfunction. Methods and results: Doppler echocardiography was performed in 972 patients with symptomatic HF. RF was considered present when deceleration time (DT) was ≤140 ms and non-RF when N 140 ms. A DT N 240 ms was defined as delayed relaxation. During a median of 51 months the unadjusted all-cause mortality rates were significantly increased among patients with RF vs. the non-RF group (1-and 4-year mortality was 25% and 54% vs. 17% and 43%). In a multivariable model, RF was a significant predictor of all-cause mortality (hazard ratio (HR) = 2.0, 95% confidence interval (CI):1.5-2.6) whereas delayed relaxation was without prognostic importance (HR = 0.9, CI:0.5-1.6). Repeating the multivariable model in subgroups of wall motion index (WMI) showed that RF was a strong predictor of mortality independent of WMI. For patients with LVEF of at least 50%, HR for RF was 2.0 (CI:1.1-3.4; p = 0.02) and interaction between LVEF and RF was not significant. Conclusion: In a heterogeneous population hospitalised for symptomatic HF a restrictive transmitral filling pattern, defined as shortened deceleration time, during hospitalisation is an ominous prognostic sign independent of LV systolic function.

The prognostic importance of a history of hypertension in patients with symptomatic heart failure is substantially worsened by a short mitral inflow deceleration time

“…As previously shown [7], having a restrictive filling pattern was associated with an increased risk of mortality, but importantly this relative risk was substantially higher among patients with hypertension than among patients without hypertension (Figure 3a). Further, the transmitral filling pattern was shown to substantially influence the outcomes associated with hypertension; p for interaction <0.001; Figure 3b.…”

“…Measurements of transmitral filling pattern (i.e., peak flow velocity and deceleration time in early diastole [E wave] and peak flow velocity in atrial contraction [A wave]) were obtained as averages of 5 consecutive cardiac cycles for patients in sinus rhythm and 10 cardiac cycles for patients in atrial fibrillation. A restrictive left ventricular filling pattern was considered present if transmitral deceleration time was below or equal to 140 ms [7]. Atrial fibrillation was no exclusion criteria, because a short deceleration time has shown to be of similar prognostic importance in patients with and without atrial fibrillation [8-10].…”

The relationship between serum fibrosis markers and restrictive ventricular filling in patients with heart failure with reduced ejection fraction: A technetium-99m radionuclide ventriculography study

“…However, relying on a univariate predictor such as LVEF to predict the prognosis is not sufficient, and patients with HFrEF and diastolic dysfunction have a lower survival rate. Both a deceleration time ≤ 140 ms and early to late flow velocity of mitral inflow > 1 mean have been shown to be powerful independent predictors of mortality according to studies which evaluated mitral inflow patterns by Doppler echocardiography [34] [35]. In addition, Temporelli et al reported that after optimal medical treatment, the patients’ response to medication with reversal of the restrictive pattern at 6 months resulted in a lower cardiac mortality rate and fewer events requiring hospitalization than those with persistence of the restrictive pattern [36].…”

Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure: a 7-year follow-up study

“…The trial design and results have been described in detail previously [20,21]. Briefly, from 2001 to 2002, 3954 consecutive patients admitted with congestive HF were screened in 43 hospitals in Scandinavia, primarily Denmark.…”

“…Cardiac cycles with fusion of early and late velocities or with nonlinear deceleration slope were excluded. RF was considered present when deceleration time was ≤140 ms [21]. …”