Visual echocardiographic scoring system of the left ventricular filling pressure and outcomes of heart failure with preserved ejection fraction

Abstract

Aims Elevated left ventricular filling pressure (LVFP) is a powerful indicator of worsening clinical outcomes in heart failure with preserved ejection fraction (HFpEF); however, detection of elevated LVFP is often challenging. This study aimed to determine the association between the newly proposed echocardiographic LVFP parameter, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score, and clinical outcomes of HFpEF. Methods and results We retrospectively investigated 310 well-differentiated HFpEF patients in stable conditions. VMT was scored from 0 to 3 using two-dimensional echocardiographic images, and VMT ≥2 was regarded as a sign of elevated LVFP. The primary endpoint was a composite of cardiac death or heart failure hospitalization during the 2 years after the echocardiographic examination. In all patients, Kaplan–Meier curves showed that VMT ≥2 (n = 54) was associated with worse outcomes than the VMT ≤1 group (n = 256) (P < 0.001). Furthermore, VMT ≥2 was associated with worse outcomes when tested in 100 HFpEF patients with atrial fibrillation (AF) (P = 0.026). In the adjusted model, VMT ≥2 was independently associated with the primary outcome (hazard ratio 2.60, 95% confidence interval 1.46–4.61; P = 0.001). Additionally, VMT scoring provided an incremental prognostic value over clinically relevant variables and diastolic function grading (χ2 10.8–16.3, P = 0.035). Conclusions In patients with HFpEF, the VMT score was independently and incrementally associated with adverse clinical outcomes. Moreover, it could also predict clinical outcomes in HFpEF patients with AF.

The prognostic value of the visually assessed time difference between mitral valve and tricuspid valve opening score for patients with heart failure with mildly reduced ejection fraction

“…Moreover, the VMT score ≥2 was confirmed to be correlated with the prognosis of HFpEF population 13 These gave evidence to the results in our study, which revealed that the VMT score ≥2 was associated with elevated risk of 1-year all-cause and the VMT score of 3 was correlated with increased risk of CVD-cause mortality.…”

“…Recently, the visually assessed time difference between the mitral valve (MV) and tricuspid valve (TV) opening (VMT), combined with an indicator of right atrial pressure [inferior vena cava (IVC) dimension], formed the VMT score 12 . The VMT score was reported to be correlated with the increase of left ventricular filling pressure (LVFP), 12 and served as a useful indicator for evaluating the prognosis of HFpEF 13 . Thus, we suspected that the VMT score might be a valuable prognostic biomarker for HFmrEF patients.…”

Adiposity and clinical outcomes in East Asian patients with heart failure and preserved ejection fraction

“…This retrospective observational study examined the association between the amount of VAT and SAT and clinical outcomes in Japanese patients with HFpEF. Some participant data from this study were previously published [7] , [19] , [20] , [21] , [22] , [23] , but not in relation to the prognostic value of adiposity. Patients presenting at Gunma University Hospital in Maebashi, Japan between January 2014 and December 2020 were screened for HFpEF.…”

Order of tricuspid and mitral valve opening as an index of left ventricular filling pressure and prognosis

“…In this edition of the journal, the same group has applied the VMT score retrospectively on 310 HFpEF patients and evaluated cardiac death and heart failure hospitalization after 2 years as primary outcome. 13 Patients with VMT ≥2 had worse outcome, and the VMT score still showed incremental value also after adjusting for other variables. Patients with VMT ≥2 showed more signs of poor function and were thus sicker, which is consistent with their previous study that patients meeting this cut-off truly have a high filling pressure.…”

“…Patients with VMT ≥2 showed more signs of poor function and were thus sicker, which is consistent with their previous study that patients meeting this cut-off truly have a high filling pressure. Notably, both the previous 6 and the new study 13 showed that VMT score performed well to stratify patients with atrial fibrillation. This is interesting because these patients tend to have monophasic LV inflow, which makes use of conventional LV filling pressure parameters problematic.…”