TY - JOUR

T1 - Prognostic value of left ventricular mitral annular longitudinal displacement obtained by tissue Doppler imaging in patients with heart failure with reduced ejection fraction

AU - Sengeløv, Morten

AU - Godsk, Peter

AU - Bruun, Niels Eske

AU - Olsen, Flemming Javier

AU - Fritz-Hansen, Thomas

AU - Biering-Sorensen, Tor

N1 - Funding Information: Funding Work for this manuscript was supported by a research grant from the Novo Nordisk Research Foundation (grant number NNF15OC0017456). Funding Information: Competing interests PG has received lecture fees from Novo Nordisk and AstraZeneca. TB-S reports receiving research grants from Sanofi Pasteur and GE Healthcare, being a Steering Committee member of the Amgen financed GALACTIC‐HF trial, on advisory boards for Sanofi Pasteur and Amgen, and speaker honorariums from Novartis and Sanofi Pasteur. Publisher Copyright: ©

PY - 2021/1/25

Y1 - 2021/1/25

N2 - Background Tissue Doppler imaging (TDI) can be used to measure the mitral annular longitudinal displacement (LD) during systole. However, the prognostic utility of global and regional LD in patients with heart failure with reduced ejection fraction (HFrEF) is unknown. Methods Echocardiographic examinations from 907 patients with HFrEF were analysed obtaining conventional echocardiographic measurements. Regional LD was obtained from colour TDI projections in six mitral annular regions and global LD was calculated as an average. Results Mean age was 67 years, 26.9% were women and mean left ventricular ejection fraction was 27%. During a median follow-up period of 40 months, 150 (16.5 %) patients died. The risk of dying increased with decreasing tertile of global LD and was approximately five times higher for patients in the lowest tertile compared with the highest (1.Tertile vs 3.Tertile, HR 4.9, 95% CI: 3.0 to 7.9, p<0.001). Global LD was a significant independent predictor of mortality after adjusting for age, gender, body mass index, pacemaker, heart rate, atrial fibrillation, diabetes and conventional echocardiographic measures and global longitudinal strain: HR 1.16 (95% CI: 1.00 to 1.34, p=0.044) per 1 mm decrease. For regional measures, inferior LD was also a significant independent predictor in the multivariable model: HR 1.16 (95% CI: 1.04 to 1.29, p=0.006) and adding inferior LD to the conventional measures yielded a significant increase in Harrell's C-statistic (95% CI: 0.75 to 0.78, p=0.009). Conclusion In patients with HFrEF, global and inferior LD are independent predictors of all-cause mortality. Furthermore, inferior LD proved to be a significant prognosticator when compared with all the conventional echocardiographic parameters.

AB - Background Tissue Doppler imaging (TDI) can be used to measure the mitral annular longitudinal displacement (LD) during systole. However, the prognostic utility of global and regional LD in patients with heart failure with reduced ejection fraction (HFrEF) is unknown. Methods Echocardiographic examinations from 907 patients with HFrEF were analysed obtaining conventional echocardiographic measurements. Regional LD was obtained from colour TDI projections in six mitral annular regions and global LD was calculated as an average. Results Mean age was 67 years, 26.9% were women and mean left ventricular ejection fraction was 27%. During a median follow-up period of 40 months, 150 (16.5 %) patients died. The risk of dying increased with decreasing tertile of global LD and was approximately five times higher for patients in the lowest tertile compared with the highest (1.Tertile vs 3.Tertile, HR 4.9, 95% CI: 3.0 to 7.9, p<0.001). Global LD was a significant independent predictor of mortality after adjusting for age, gender, body mass index, pacemaker, heart rate, atrial fibrillation, diabetes and conventional echocardiographic measures and global longitudinal strain: HR 1.16 (95% CI: 1.00 to 1.34, p=0.044) per 1 mm decrease. For regional measures, inferior LD was also a significant independent predictor in the multivariable model: HR 1.16 (95% CI: 1.04 to 1.29, p=0.006) and adding inferior LD to the conventional measures yielded a significant increase in Harrell's C-statistic (95% CI: 0.75 to 0.78, p=0.009). Conclusion In patients with HFrEF, global and inferior LD are independent predictors of all-cause mortality. Furthermore, inferior LD proved to be a significant prognosticator when compared with all the conventional echocardiographic parameters.

KW - cardiac imaging techniques

KW - diagnostic imaging

KW - echocardiography

U2 - 10.1136/openhrt-2020-001494

DO - 10.1136/openhrt-2020-001494

M3 - Journal article

C2 - 33495381

AN - SCOPUS:85099971385

VL - 8

JO - Open Heart

JF - Open Heart

SN - 2398-595X

IS - 1

M1 - e001494

ER -