Impact of blunted pulmonary venous flow on the outcome of patients with left ventricular systolic dysfunction secondary to either ischemic or idiopathic dilated cardiomyopathy

The intravenous administration of echo contrast agents enhances the Doppler signal and makes the study of pulmonary venous flow (PVF) easily achievabl e by transthoracic echocardiography. The aim of this study was to evaluate whether PVF patterns play a role in predicting the outcome of patients with left ventricular (LV) systolic dysfunction. Thus, 115 patients (79 men, me an age 69 years) with LV dysfunction (ejection fraction [EF] <45%) due to e ither ischemic or idiopathic dilated cardiomyopathy were studied and follow ed-up for 1 year. A quantitative interrogation of all components of PVF was feasible in 69% of patients at standard transthoracic examination; after c ontrast enhancement, anterograde and retrograde flow velocities were measur able in 100% and 92% of patients, respectively. A blunted PVF (defined by a systolic-to-diastolic peak velocity ratio <1) was identified in 48 patient s (42%), who had a worse clinical status, a lower LVEF, and a more severe p ulmonary hypertension. Thirty-six patients had cardiac events at follow-up sudden death in 4, progressive heart failure in 12, and hospitalization for worsening heart failure in 20 patients. Multivariate Cox proportional-haza rds analysis revealed that advanced New York Heart Association class, male gender, and older age were independent predictors of mortality. However, bl unted PVF, reduced LVEF, older age, and increased heart rate in descending order of power were independent predictors of heart failure hospitalization s and deaths from end-stage heart failure. In conclusion, the assessments o f PVF may effectively contribute to the characterization of patients with L V dysfunction and to the prediction of their outcome. (C) 2000 by Excerpta Medica, Inc.