Transmitral flow patterns and the presence of chronic kidney disease provide independent and incremental prognostic information in patients with heart failure and systolic dysfunction

Background: Transmitral flow patterns derived from Doppler echocardiography carry prognostic information in patients with chronic heart failure and systolic dysfunction. in such patients, chronic kidney disease (CKD) defined as a reduction in estimated glomerular filtration rate less than 60 ml./min/1.73 M-2 is frequent, but its prognostic impact relative to that of transmitral flow patterns is unknown. Methods: This prospective study enrolled 292 patients with stable chronic heart failure and systolic dysfunction (mean ejection fraction 30 10), of whom 148 had CKD. Echocardiographic measurements comprised left ventricular dimensions/volumes, ejection fraction, the ratio of early (E) to late (A) transmitral flow velocity, deceleration time, and tissue Doppler mitral annular velocities. The mitral filling pattern (FP) was classified as either restrictive FP (RFP) or non-RFP. A cardiac event (cardiac death or urgent cardiac transplantation) was defined as combined study end point. Results: During a follow-up of 497 373 days, 45 patients had a cardiac event (cardiac death, n = 42; urgent cardiac transplantation, n = 3). On multivariate Cox analysis including clinical and echocardiographic variables, independent prognostic predictors were RFP (hazard ratio: 2.77, 95% confidence interval 1.28-6.09), CKD (hazard ratio: 2.79, 95% confidence interval 1.24-6.28), and left atrial diameter. In patients with RFP, the prognosis was markedly worse in the presence of CKD as compared with the absence (event-free survival of 23% vs 83%, P =.03). Similarly, in patients with non-RFP, outcome was worse in the presence of CKD (event-free survival of 71% vs 88%, P =.003). Conclusions: In patients with chronic heart failure and systolic dysfunction, the presence of CKD adds incremental value to transmitral flow patterns in determining the prognosis.