Jacob C Jentzer1, Nandan S Anavekar2, Sunil V Mankad3, Majd Khasawneh4, Roger D White5, Gregory W Barsness6, Alejandro A Rabinstein7, Kianoush B Kashani8, Sorin V Pislaru9. 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: jentzer.jacob@mayo.edu. 2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: anavekar.nandan@mayo.edu. 3. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: mankad.sunil@mayo.edu. 4. Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI, United States of America. 5. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: white.roger@mayo.edu. 6. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: barsness.gregory@mayo.edu. 7. Department of Neurology, Mayo Clinic, Rochester, MN, United States of America. Electronic address: rabinstein.alejandro@mayo.edu. 8. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America; Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: kashani.kianoush@mayo.edu. 9. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: pislaru.sorin@mayo.edu.
Abstract
PURPOSE: To determine whether systolic or diastolic dysfunction on transthoracic echocardiogram (TTE) predicts mortality after out-of-hospital cardiac arrest (OHCA). METHODS: Retrospective cohort study of 173 OHCA subjects undergoing targeted temperature management who underwent TTE during hospitalization. Univariate analysis and multivariate logistic regression were used to determine associations between TTE measurements of systolic and diastolic function and systemic hemodynamics with all-cause mortality. RESULTS: Mean age was 61.6 ± 12.4 years (72.7% male) and initial rhythm was shockable in 89%. Hospital mortality was 30.6%. Mean LVEF was 40% and was not different in hospital survivors (p = 0.81). TTE parameters reflecting systolic function and systemic hemodynamics did not predict hospital mortality. Medial mitral E/e' ratio was associated with hospital mortality, with an optimal cut-off > 13 (p = 0.002). After multivariate adjustment, medial mitral E/e' ratio remained predictive of hospital mortality (OR 1.11, 95% CI 1.03-1.20, p = 0.004). Subjects with a medial mitral E/e' ratio > 13 had higher mortality during long-term follow-up (p < 0.001 by log-rank). CONCLUSIONS: Diastolic dysfunction (higher medial mitral E/e' ratio) on TTE independently predicted mortality after OHCA; systolic dysfunction and TTE hemodynamic parameters did not. This reflects a novel use of Doppler TTE to predict outcomes after OHCA.
PURPOSE: To determine whether systolic or diastolic dysfunction on transthoracic echocardiogram (TTE) predicts mortality after out-of-hospital cardiac arrest (OHCA). METHODS: Retrospective cohort study of 173 OHCA subjects undergoing targeted temperature management who underwent TTE during hospitalization. Univariate analysis and multivariate logistic regression were used to determine associations between TTE measurements of systolic and diastolic function and systemic hemodynamics with all-cause mortality. RESULTS: Mean age was 61.6 ± 12.4 years (72.7% male) and initial rhythm was shockable in 89%. Hospital mortality was 30.6%. Mean LVEF was 40% and was not different in hospital survivors (p = 0.81). TTE parameters reflecting systolic function and systemic hemodynamics did not predict hospital mortality. Medial mitral E/e' ratio was associated with hospital mortality, with an optimal cut-off > 13 (p = 0.002). After multivariate adjustment, medial mitral E/e' ratio remained predictive of hospital mortality (OR 1.11, 95% CI 1.03-1.20, p = 0.004). Subjects with a medial mitral E/e' ratio > 13 had higher mortality during long-term follow-up (p < 0.001 by log-rank). CONCLUSIONS:Diastolic dysfunction (higher medial mitral E/e' ratio) on TTE independently predicted mortality after OHCA; systolic dysfunction and TTE hemodynamic parameters did not. This reflects a novel use of Doppler TTE to predict outcomes after OHCA.
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