Usefulness of Doppler Echocardiographic Left Ventricular Diastolic Function and Peak Exercise Oxygen Consumption to Predict Cardiovascular Outcomes in Patients With Systolic Heart Failure (from HF-ACTION)

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• 作者：Julius M. Gardin ; Eric S. Leifer ; Dalane W. Kitzman ; Gerald Cohen ; Joel S. L ; zberg ; William Cotts ; Eugene E. Wolfel ; Robert E. Safford ; Renee L. Bess ; Jerome L. Fleg
• 刊名：The American Journal of Cardiology
• 出版年：2012
• 出版时间：15 September, 2012
• 年：2012
• 卷：110
• 期：6
• 页码：862-869
• 全文大小：1247 K

文摘

Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) was a multicenter, randomized controlled trial designed to examine the safety and efficacy of aerobic exercise training versus usual care in 2,331 patients with systolic heart failure (HF). In HF-ACTION patients with rest transthoracic echocardiographic measurements, the predictive value of 8 Doppler echocardiographic measurements¡ªleft ventricular (LV) diastolic dimension, mass, systolic (ejection fraction) and diastolic (mitral valve peak early diastolic/peak late diastolic [E/A] ratio, peak mitral valve early diastolic velocity/tissue Doppler peak early diastolic myocardial velocity [E/E¡ä] ratio, and deceleration time) function, left atrial dimension, and mitral regurgitation severity¡ªwas examined for a primary end point of all-cause death or hospitalization and a secondary end point of cardiovascular disease death or HF hospitalization. Also compared was the prognostic value of echocardiographic variables versus peak oxygen consumption (Vo₂). Mitral valve E/A and E/E¡ä ratios were more powerful independent predictors of clinical end points than the LV ejection fraction but less powerful than peak Vo₂. In multivariate analyses for predicting the primary end point, adding E/A ratio to a basic demographic and clinical model increased the C-index from 0.61 to 0.62, compared with 0.64 after adding peak Vo₂. For the secondary end point, 6 echocardiographic variables, but not the LV ejection fraction or left atrial dimension, provided independent predictive power over the basic model. The addition of E/E¡ä or E/A to the basic model increased the C-index from 0.70 to 0.72 and 0.73, respectively (all p values <0.0001). Simultaneously adding E/A ratio and peak Vo₂ to the basic model increased the C-index to 0.75 (p <0.0005). No echocardiographic variable was significantly related to the change from baseline to 3 months in exercise peak Vo₂. In conclusion, the addition of echocardiographic LV diastolic function variables improves the prognostic value of a basic demographic and clinical model for cardiovascular disease outcomes.