Prognostic value of Doppler echocardiographic mitral inflow patterns: Implications for risk stratification in patients with chronic congestive heart failure

OBJECTIVES This prospective study tested whether transmitral flow patterns add incremental value to peak oxygen consumption ((V)over dotO(2)) in determining the prognosis of patients with chronic congestive heart failure (CHF) and systolic dysfunction. BACKGROUND Peak (V)over dotO(2) is an objective marker of functional capacity and is routinely used as a criterion to identify heart transplant candidates. Diastolic dysfunction limits functional capacity, but its prognostic importance relative to that of peak (V)over dotO(2) is unknown. METHODS Peak (V)over dotO(2), and mitral inflow velocities were prospectively measured in 311 consecutive patients (mean age 54 years, 84% male) with impaired left ventricular function (ejection fraction <40%; 88 patients with ischemic and 223 with dilated cardiomyopathy) who were evaluated for heart transplant candidacy. RESULTS During a mean follow-up period of 512 <plus/minus> 314 days, 65 patients died and 43 patients underwent heart transplantation. Diastolic filling patterns, peak (V)over dotO(2) and left ventricular end-diastolic diameters were independent predictors of cardiac mortality. In patients with peak (V)over dotO(2) less than or equal to 14 ml/min per kg body weight, the outcome was markedly poorer in the presence of restrictive filling patterns as compared with their absence (two-year survival rate 52% vs. 80%). Similarly, despite peak (V)over dotO(2) levels >14 ml/min per kg, the outcome was less favorable in the presence of restrictive filling patterns (two-year survival rate 80% vs. 94%). A risk-stratification model based on the identified independent noninvasive predictors separated groups into those with high (93%), intermediate (65%) and low (39%) two-year survival rates. CONCLUSIONS Transmitral Row patterns add incremental value to peak (V)over dotO(2) in determining the prognosis of patients with CHF and impaired systolic function. (J Am Coll Cardiol 2001;37:1049-55) (C) 2001 by the American College of Cardiology.