PROGNOSTIC VALUE OF A DOPPLER INDEX COMBINING SYSTOLIC AND DIASTOLIC PERFORMANCE IN IDIOPATHIC-DILATED CARDIOMYOPATHY

This study sought to investigate, in patients with idiopathic-dilated cardiomyopathy, the clinical and prognostic value of a Doppler-derived index of myocardial function that combines systolic and diastolic tim e intervals of the left heart cycle. The Doppler index was measured in 75 patients (aged 61 +/- 13 years; 45 men and 30 women) in sinus rhyt hm and 75 age- and sex-matched controls. Ejection time was measured fr om the left ventricular outflow Doppler signal. The sum of isovolumic times was obtained by subtracting the election time from the interval between cessation and onset of mitral inflow measured from the mitral inflow velocity profile. The index was the sum of isovolumic times div ided by ejection time. The values of the Doppler index in patients wit h idiopathic-dilated cardiomyopathy (0.85 +/- 0.32) were significantly higher than values in controls (0.37 +/- 0.08, p < 0.001). During fol low-up of 5 years, 1 patient underwent cardiac transplantation and 36 patients died, 29 of cardiac, 5 of noncardiac, and 2 of unknown causes . Univariate analysis demonstrated that the Doppler index (chi-square = 18.3, p < 0.001), ejection fraction (chi-square = 15.2, p <0.001), s ymptom status (chi-sqvare = 9.2, p = 0.002), and mitral deceleration t ime (chi-square = 5.2, p = 0.02) were significant predictors of outcom e, However, multivariate stepwise analysis of these variables showed t hat the Doppler index (chi-square = 10.7, p = 0.001) and ejection frac tion (chi-square = 6.7, p = 0.01) were the most significant independen t predictors of outcome. The Doppler index reflects disease severity a nd has incremental prognostic value in dilated cardiomyopathy. Ease of use, nongeometric dependency, excellent separation of clinical groups , and a strong relation to outcome enhance its appeal. (C)1998 by Exce rpta Medica, Inc.