Doppler-derived dP/dt and -dP/dt predict survival in congestive heart failure

OBJECTIVES The purpose of this study was to evaluate the ability of novel D oppler indices of left ventricular (LV) systolic and diastolic function to predict survival in patients with congestive heart failure (CHF). BACKGROUND Congestive heart failure is associated with an increased risk of death or cardiac transplantation, yet techniques to predict survival are l imited. METHODS Doppler-derived dP/dt and - dP/dt were determined prospectively fro m the continuous-wave Doppler spectrum of the mitral regurgitation jet (dP/ dt = 32/time between 1 and 3 m/s; -dP/dt = 32/time between 3 and 1 m/s) in 56 patients with chronic CHF (age, 60 +/- 15 years; LV ejection fraction, 2 3 +/- 9%). Baseline clinical and echocardiographic variables were also obta ined, and clinical follow-up was performed in all patients. RESULTS Twenty-four patients experienced a primary event of cardiac death ( n = 15), United Network for Organ ShariIlg status I (inotrope-dependent) he art transplant (n = 3) or urgent implantation of a LV assist device (n = 6) . Doppler-derived dP/dt (dichotomized to greater than or equal to or <600 m m Hg/s; p = 0.0002) and -dP/dt (trichotomized to <450, 450 to 550 and >550 mm Hg/s; p = 0.0001) predicted event-free survival, as did Doppler-derived risk groups determined by the combination of the two (low risk, dP/dt great er than or equal to 600; intermediate risk, dP/dt < 600 and -dP/dt a: 450; high risk, dP/dt < 600 and -dP/dt < 450; p = 0.0001). Multivariable analysi s revealed Doppler-derived risk groups, intravenous inotrope requirement an d blood urea nitrogen as significant independent predictors of outcome. CONCLUSIONS New Doppler indices of dP/dt, - dP/dt and risk groups defined b y the combination of dP/dt and -dP/dt predict event-free survival in patien ts with CHF. (C) 2000 by the American College of Cardiology.