Jy. Tabet et al., Comparison of the prognostic value of left ventricular filling and peak oxygen uptake in patients with systolic heart failure, EUR HEART J, 21(22), 2000, pp. 1864-1871
Aim The aim of this prospective study was to compare the prognostic value o
f the mitral inflow pattern and peak oxygen uptake in patients with systoli
c heart failure.
Background Peak oxygen uptake is a major prognostic parameter in heart fail
ure. It is not known whether a restrictive mitral inflow pattern has simila
r prognostic value.
Methods One hundred heart failure patients (ejection fraction <45%) underwe
nt exercise testing after Doppler evaluation; prognosis was assessed after
a mean follow-up of 17 months.
Results The ejection fraction was larger in group 1 (nonrestrictive pattern
: EIA mitral wave ratio <1 or between 1 and 2 with E wave deceleration time
greater than or equal to 140 ms, n=45) than in group 2 (restrictive patter
n: EIA ratio >2 or between 1 and 2 with E deceleration time <140 ms: n=40)
(29 +/- 9 vs 22 +/- 10%, P<0.05). Peak oxygen uptake was lower in group 2 (
17 +/- 4 vs 22 +/- 5 ml . min(-1).kg(-1) 57 +/- 11 vs 75 +/- 15% of predict
ed values; P<0.05 for both comparisons). Univariate analysis showed that th
e deceleration time (r=0.65), E/A ratio (r= - 0.50) and heart rate incremen
t (r=0.47) correlated best with peak oxygen uptake. A third group of patien
ts with persistent fusion of the E and A waves (n = 15) had exercise respon
ses similar to those of group 2 patients. A short deceleration time (P=0.00
6), a restrictive or a fusion pattern (P=0.04) were associated with a poor
outcome; the prognostic value of these Doppler variables was greater than t
hat of ejection fraction, but remained less than peak oxygen uptake indexed
by predicted values (P=0.0004).
Conclusion The left ventricular filling pattern is a strong predictor of ex
ercise capacity, and outcome, in patients with systolic heart failure and i
s independent of the left ventricular election fraction. Peak oxygen uptake
remains a more powerful prognostic variable. (EUF Heart J 2000; 21: 1864-1
871, doi:10.1053/euhj.2000. 2174) (C) 2000 The European Society of Cardiolo
gy.