DOPPLER-ECHOCARDIOGRAPHIC STUDY OF MITRAL FLOW VELOCITIES AND THE PROGNOSIS OF CARDIAC-FAILURE

The aim of this study was to determine the role of Doppler echocardiog raphy in establishing the prognosis of Stages to 4 cardiac failure. Th e echocardiographic indices of left ventricular filling were correlate d with catheter data and the 2 year out come of patients. The study po pulation included 54 patients examined prospectively in the context of an evaluation of their cardiac failure. Two years after the initial e xamination, 19 patients were dead or transplanted. Of the remaining 35 patients, 18 were reevaluated at 6 months. Of the echocardiographic p arameters, << hyper normal >> mitral flow with a high E/A ration indic ated poor prognosis ; when E/A > 2, the one year survival was 50 % and the 2 year survival 42 %. There was overlap between the groups of dea d or transplanted and surviving patients only when the E/A ratio was b etween 2 and 3. The patients with E/A < 2 were all alive without any m ajor events at 2 years. All patients with E/A > 3 had a poor prognosis . The E/A ratio was closely correlated with pulmonary capillary pressu re levels (p < 0.001, r = 0.55) and lees closely with cardiac index (p < 0.05, r = 0.4) and radionuclide ejection fraction (p < 0.05, r = 0. 28). After 6 months' vasodilator treatment with an angiotensin convert ing enzyme inhibitor (captopril) the E/A ratio decreased significantly from 1.85 +/- 0.78 to 1.0 0.55 (p < 0.02). A << hyper-normal >> mitra l flow is related to many factors, including high left ventricular fil ling pressures, mitral regurgitation and reduced left ventricular comp liance. This appearance of mitral flow is a poor prognosis factor in s evere cardiac failure.