Eric Buffle1, Judith Kramarz1, Esther Elazar1, Galit Aviram2, Meirav Ingbir1, Nahum Nesher3, Simon Biner1, Gad Keren1, Yan Topilsky4. 1. The Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel. 2. The Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel. 3. Division of Cardiovascular Surgery, Tel Aviv Medical Center, Tel Aviv, Israel. 4. The Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel topilskyyan@gmail.com.
Abstract
AIMS: To evaluate the prognostic role of pulmonary venous flow parameters and their role in patients with preserved ejection fraction (EF). METHODS AND RESULTS: Pulmonary venous flow parameters were measured in 365 patients in sinus rhythm, without significant mitral disease, and EF >50% (age 64.9 ± 19; 52% female) by a single sonographer. Survival, time to re-admission for heart failure, and to a combined cardiac end point (cardiac death, heart failure, and atrial fibrillation) were retrospectively analysed and correlated to echo parameters. Systolic (S) and diastolic (D) pulmonary vein flow were obtainable in 73% of patients and Ar in 65%. The lower peak S/D ratio and higher ΔAr-A time were associated with higher rate of heart failure readmission (P = 0.03 for both). The S/D integral ratio was the best pulmonary vein flow predictor of heart failure readmissions (P = 0.0009), better than the peak S/D ratio, or ΔA-Ar time (P < 0.01 for both), and independently predicted worse outcome even when adjusted for diastolic grading (using recent guidelines), left ventricle mass index, E/e', and left atrial volume index (P < 0.05 for all). The addition S/D ratio to diastolic grading recognized patients with pseudo-normal filling pattern and S/D ratio >1 with similar clinical outcomes to grade I (P > 0.5), but worse clinical outcomes than in the pseudo-normal patients with lower S/D ratio (P < 0.01). CONCLUSIONS: PVFP are obtainable in most patients, add prognostic information on top of routine diastolic parameters, and define an early stage of diastolic dysfunction resembling the pseudo-normal pattern in which S/D ratio is >1, and outcome is excellent. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To evaluate the prognostic role of pulmonary venous flow parameters and their role in patients with preserved ejection fraction (EF). METHODS AND RESULTS: Pulmonary venous flow parameters were measured in 365 patients in sinus rhythm, without significant mitral disease, and EF >50% (age 64.9 ± 19; 52% female) by a single sonographer. Survival, time to re-admission for heart failure, and to a combined cardiac end point (cardiac death, heart failure, and atrial fibrillation) were retrospectively analysed and correlated to echo parameters. Systolic (S) and diastolic (D) pulmonary vein flow were obtainable in 73% of patients and Ar in 65%. The lower peak S/D ratio and higher ΔAr-A time were associated with higher rate of heart failure readmission (P = 0.03 for both). The S/D integral ratio was the best pulmonary vein flow predictor of heart failure readmissions (P = 0.0009), better than the peak S/D ratio, or ΔA-Ar time (P < 0.01 for both), and independently predicted worse outcome even when adjusted for diastolic grading (using recent guidelines), left ventricle mass index, E/e', and left atrial volume index (P < 0.05 for all). The addition S/D ratio to diastolic grading recognized patients with pseudo-normal filling pattern and S/D ratio >1 with similar clinical outcomes to grade I (P > 0.5), but worse clinical outcomes than in the pseudo-normal patients with lower S/D ratio (P < 0.01). CONCLUSIONS: PVFP are obtainable in most patients, add prognostic information on top of routine diastolic parameters, and define an early stage of diastolic dysfunction resembling the pseudo-normal pattern in which S/D ratio is >1, and outcome is excellent. Published on behalf of the European Society of Cardiology. All rights reserved.
Keywords:
difference from mitral A-wave duration; ejection fraction; left atrium; left ventricle; pulmonary venous flow parameters; systolic to diastolic ratio
Authors: Morgane Evin; Kathryn M Broadhouse; Fraser M Callaghan; Rachel T McGrath; Sarah Glastras; Rebecca Kozor; Samantha L Hocking; Jérôme Lamy; Alban Redheuil; Nadjia Kachenoura; Greg R Fulcher; Gemma A Figtree; Stuart M Grieve Journal: Cardiovasc Diabetol Date: 2016-12-22 Impact factor: 9.951
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