Comparison of the prognostic value of left ventricular filling and peak oxygen uptake in patients with systolic heart failure.

AIM: The aim of this prospective study was to compare the prognostic value of the mitral inflow pattern and peak oxygen uptake in patients with systolic heart failure.
BACKGROUND: Peak oxygen uptake is a major prognostic parameter in heart failure. It is not known whether a restrictive mitral inflow pattern has similar prognostic value.
METHODS: One hundred heart failure patients (ejection fraction <45%) underwent 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 (non-restrictive pattern: E/A mitral wave ratio <1 or between 1 and 2 with E wave deceleration time >/=140 ms, n=45) than in group 2 (restrictive pattern: E/A 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 predicted values;P<0.05 for both comparisons). Univariate analysis showed that the deceleration time (r=0.65), E/A ratio (r=-0.50) and heart rate increment (r=0.47) correlated best with peak oxygen uptake. A third group of patients with persistent fusion of the E and A waves (n=15) had exercise responses similar to those of group 2 patients. A short deceleration time (P=0.006), 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 that 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 exercise capacity, and outcome, in patients with systolic heart failure and is independent of the left ventricular ejection fraction. Peak oxygen uptake remains a more powerful prognostic variable. Copyright 2000 The European Society of Cardiology.