TY - JOUR
T1 - Added value of pulmonary venous flow Doppler assessment in patients with preserved ejection fractionandits contribution tothediastolicgrading paradigm
AU - Buffle, Eric
AU - Kramarz, Judith
AU - Elazar, Esther
AU - Aviram, Galit
AU - Ingbir, Meirav
AU - Nesher, Nahum
AU - Biner, Simon
AU - Keren, Gad
AU - Topilsky, Yan
N1 - Publisher Copyright:
© 2015 The Author.
PY - 2015/11
Y1 - 2015/11
N2 - 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.
AB - 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.
KW - Pulmonary venous flow parameters
KW - difference from mitral A-wave duration
KW - ejection fraction
KW - left atrium
KW - left ventricle
KW - systolic to diastolic ratio
UR - http://www.scopus.com/inward/record.url?scp=84948668660&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jev126
DO - 10.1093/ehjci/jev126
M3 - מאמר
AN - SCOPUS:84948668660
VL - 16
SP - 1191
EP - 1197
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
SN - 2047-2404
IS - 11
ER -