Relation Between Echocardiogram-based Cardiac Parameters and Outcome in Heart Failure with Preserved and Reduced Ejection Fraction

• Published in: The American journal of cardiology 2016-11, Vol.118 (9), p.1356-1362
• Main Authors: Obokata, Masaru, MD, Takeuchi, Masaaki, MD, Negishi, Kazuaki, MD, Ohte, Nobuyuki, MD, Izumo, Masaki, MD, Yamashita, Eiji, MD, Ebato, Mio, MD, Yuda, Satoshi, MD, Kurabayashi, Masahiko, MD, Nakatani, Satoshi, MD
• Format: Article
• Language: English
• Subjects: Aged; Cardiovascular; Echocardiography, Doppler; Electrocardiography; Female; Fractions; Heart attacks; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Humans; Male; Predictive Value of Tests; Prognosis; Prospective Studies; Pulmonary arteries; Stroke Volume - physiology; Ultrasonic imaging; Variables; Velocity
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.07.060

Abstract The purposes of this study were to investigate whether heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) share echocardiographic predictors, and elucidate the E/(e' x s') predicts major adverse cardiovascular events (MACE) independent of other echocardiographic parameters in each HF group. We assessed tissue Doppler-derived parameters [E/e', E/(e' x s')], and left ventricular (LV) and right ventricular (RV) longitudinal strains in HFrEF (n=340) and HFpEF (n=102). LV and RV longitudinal strains were significantly higher and E/(e' x s') was lower in HFpEF patients compared with those with HFrEF, while E/e' was similar between the groups. During a median follow-up of 342 days, MACE developed in 95 HFrEF and 29 HFpEF patients. The univariable analysis revealed similar echocardiographic predictors between the two groups, including E/e', E/(e' x s') and pulmonary artery systolic pressure. No 2D speckle tracking-derived parameter remained significant in multivariable models in each HF group. E/(e' x s') was an only independent predictor with an incremental prognostic value over the MAGGIC score, and was superior to the E/e' ratio in both HFrEF and HFpEF. In conclusion, despite differences in echocardiography-based cardiac function parameters between HFrEF and HFpEF, these HF phenotypes shared the same echocardiographic predictors of future MACE. E/(e' x s') was an only independent predictor for future cardiac events in both HF populations.