Added value of pulmonary venous flow Doppler assessment in patients with preserved ejection fractionandits contribution tothediastolicgrading paradigm

Eric Buffle, Judith Kramarz, Esther Elazar, Galit Aviram, Meirav Ingbir, Nahum Nesher, Simon Biner, Gad Keren, Yan Topilsky*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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 flowparameterswere 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 DAr-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 DA-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 pseudonormal 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.

Original languageEnglish
Pages (from-to)1191-1197
Number of pages7
JournalEuropean Heart Journal Cardiovascular Imaging
Volume16
Issue number11
DOIs
StatePublished - Nov 2015
Externally publishedYes

Keywords

  • Pulmonary venous flow parameters
  • difference from mitral A-wave duration
  • ejection fraction
  • left atrium
  • left ventricle
  • systolic to diastolic ratio

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