Doppler-derived dP/dt and -dP/dt predict survival in congestive heart failure

被引:68
作者
Kolias, TJ [1 ]
Aaronson, KD [1 ]
Armstrong, WF [1 ]
机构
[1] Univ Michigan, Med Ctr, Div Cardiol, Ann Arbor, MI 48109 USA
关键词
D O I
10.1016/S0735-1097(00)00908-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The purpose of this study was to evaluate the ability of novel Doppler indices of left ventricular (LV) systolic and diastolic function to predict survival in patients with congestive heart failure (CHF). BACKGROUND Congestive heart failure is associated with an increased risk of death or cardiac transplantation, yet techniques to predict survival are limited. METHODS Doppler-derived dP/dt and - dP/dt were determined prospectively from the continuous-wave Doppler spectrum of the mitral regurgitation jet (dP/dt = 32/time between 1 and 3 m/s; -dP/dt = 32/time between 3 and 1 m/s) in 56 patients with chronic CHF (age, 60 +/- 15 years; LV ejection fraction, 23 +/- 9%). Baseline clinical and echocardiographic variables were also obtained, and clinical follow-up was performed in all patients. RESULTS Twenty-four patients experienced a primary event of cardiac death (n = 15), United Network for Organ ShariIlg status I (inotrope-dependent) heart transplant (n = 3) or urgent implantation of a LV assist device (n = 6). Doppler-derived dP/dt (dichotomized to greater than or equal to or <600 mm Hg/s; p = 0.0002) and -dP/dt (trichotomized to <450, 450 to 550 and >550 mm Hg/s; p = 0.0001) predicted event-free survival, as did Doppler-derived risk groups determined by the combination of the two (low risk, dP/dt greater than or equal to 600; intermediate risk, dP/dt < 600 and -dP/dt a: 450; high risk, dP/dt < 600 and -dP/dt < 450; p = 0.0001). Multivariable analysis revealed Doppler-derived risk groups, intravenous inotrope requirement and blood urea nitrogen as significant independent predictors of outcome. CONCLUSIONS New Doppler indices of dP/dt, - dP/dt and risk groups defined by the combination of dP/dt and -dP/dt predict event-free survival in patients with CHF. (C) 2000 by the American College of Cardiology.
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页码:1594 / 1599
页数:6
相关论文
共 25 条
[1]   Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation [J].
Aaronson, KD ;
Schwartz, JS ;
Chen, TM ;
Wong, KL ;
Goin, JE ;
Mancini, DM .
CIRCULATION, 1997, 95 (12) :2660-2667
[2]   A NEW METHOD FOR ESTIMATING LEFT-VENTRICULAR DP DT BY CONTINUOUS WAVE DOPPLER-ECHOCARDIOGRAPHY - VALIDATION STUDIES AT CARDIAC-CATHETERIZATION [J].
BARGIGGIA, GS ;
BERTUCCI, C ;
RECUSANI, F ;
RAISARO, A ;
DESERVI, S ;
VALDESCRUZ, LM ;
SAHN, DJ ;
TRONCONI, L .
CIRCULATION, 1989, 80 (05) :1287-1292
[3]   Doppler-Derived left ventricular rate of pressure rise and inotropic requirements during mitral valve surgery [J].
Broka, SM ;
Ducart, AR ;
Jamart, J ;
Collard, EL ;
Fournet, XR ;
Chevalier, S ;
Marchandise, BA ;
Joucken, KL .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 1998, 12 (01) :27-32
[4]   NONINVASIVE ESTIMATION OF THE INSTANTANEOUS 1ST DERIVATIVE OF LEFT-VENTRICULAR PRESSURE USING CONTINUOUS-WAVE DOPPLER ECHOCARDIOGRAPHY [J].
CHEN, C ;
RODRIGUEZ, L ;
GUERRERO, JL ;
MARSHALL, S ;
LEVINE, RA ;
WEYMAN, AE ;
THOMAS, JD .
CIRCULATION, 1991, 83 (06) :2101-2110
[5]   CONTINUOUS-WAVE DOPPLER-ECHOCARDIOGRAPHY FOR NONINVASIVE ASSESSMENT OF LEFT-VENTRICULAR DP/DT AND RELAXATION-TIME CONSTANT FROM MITRAL REGURGITANT SPECTRA IN PATIENTS [J].
CHEN, CG ;
RODRIGUEZ, L ;
LETHOR, JP ;
LEVINE, RA ;
SEMIGRAN, MS ;
FIFER, MA ;
WEYMAN, AE ;
THOMAS, JD .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1994, 23 (04) :970-976
[6]   NONINVASIVE MEASUREMENT OF THE TIME CONSTANT OF LEFT-VENTRICULAR RELAXATION USING THE CONTINUOUS-WAVE DOPPLER VELOCITY PROFILE OF MITRAL REGURGITATION [J].
CHEN, CG ;
RODRIGUEZ, L ;
LEVINE, RA ;
WEYMAN, AE ;
THOMAS, JD .
CIRCULATION, 1992, 86 (01) :272-278
[7]   PRELOAD DEPENDENCE OF DOPPLER-DERIVED INDEXES OF LEFT-VENTRICULAR DIASTOLIC FUNCTION IN HUMANS [J].
CHOONG, CY ;
HERRMANN, HC ;
WEYMAN, AE ;
FIFER, MA .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1987, 10 (04) :800-808
[8]   PREDICTORS OF TOTAL MORTALITY AND SUDDEN-DEATH IN MILD TO MODERATE HEART-FAILURE [J].
GRADMAN, A ;
DEEDWANIA, P ;
CODY, R ;
MASSIE, B ;
PACKER, M ;
PITT, B ;
GOLDSTEIN, S .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1989, 14 (03) :564-570
[9]  
JOHNSON G, 1993, CIRCULATION, V87, P32
[10]   COMPARATIVE INFLUENCE OF LOAD VERSUS INOTROPIC STATES ON INDEXES OF VENTRICULAR CONTRACTILITY - EXPERIMENTAL AND THEORETICAL-ANALYSIS BASED ON PRESSURE-VOLUME RELATIONSHIPS [J].
KASS, DA ;
MAUGHAN, WL ;
GUO, ZM ;
KONO, A ;
SUNAGAWA, K ;
SAGAWA, K .
CIRCULATION, 1987, 76 (06) :1422-1436