Value of tissue Doppler imaging for risk stratification of patients with chronic systolic heart failure with or without restrictive mitral flow

The aim of this study was to assess the prognostic value of tissue Doppler imaging (TDI) in patients with chronic systolic heart failure (HF) with or without restrictive mitral flow (RMF). Echocardiograms were obtained in 378 patients with chronic systolic HF [ejection fraction (EF) <= 45%] in sinus rhythm. Restrictive mitral flow was defined by an E wave deceleration time (EDT) <= 140 ms. Tissue Doppler imaging early (E(m)) diastolic and systolic (S(m)) velocities were measured at the mitral annulus. Patients were followed-up for a median of 32 months. Endpoints were all-cause mortality and the combination of death or HF hospitalization. Mean left ventricular EF was 32 +/- 8%. Restrictive mitral flow and TDI annular velocities were all univariate predictors of the endpoints. Ejection fraction < 25% was the only multivariate predictor of all-cause mortality. E wave deceleration time and E(m) < 8 cm/s were independently associated with the combined endpoint of death or HF hospitalization. At 48 months, survival was 61% in patients with RMF and 82% in patients with non-RMF (log-rank: 21.6; P < 0.0001). When patients were stratified according to E(m) at or above 8 cm/s or below 8 cm/s, those with RMF and E(m) < 8 cm/s exhibited the worst survival (log-rank: 27.16; P < 0.0001). Patients with S(m) <= 6 cm/s had a 58% survival rate, whereas it was 82% in patients with S(m) > 6 cm/s (log-rank: 12.73; P = 0.0004). Doppler annular velocities provided useful information for prognostication of patients with systolic HF. Particularly, categorization of patients according to E(m) velocities allowed us to further stratify patients with RMF and non-RMF.