Reversible restrictive left ventricular diastolic filling with optimized oral therapy predicts a more favorable prognosis in patients with chronic heart failure

Pier L. Temporelli, Ugo Corrà, Alessandro Imparato, Enzo Bosimini, Francesco Scapellato, Pantaleo Giannuzzi

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Abstract

Objectives. We sought to assess whether in clinically stable patients with chronic heart failure (CHF) the prolongation (i.e., increase) of an initially short (≤125 ms) Doppler transmittal deceleration time (DT) of early filling obtained with long-term optimal oral therapy predicts a more favorable prognosis. Background. It has been recently demonstrated that transmitral early DT is a powerful independent predictor of poor prognosis in patients with left ventricular dysfunction. However, DT may change over time according to loading conditions and medical treatment. Method. One hundred forty-four patients with CHF and a short DT (≤125 ms) underwent repeat Doppler echocardiographic study 6 months after the initial examination, while clinically stable with optimal oral therapy, and were then followed up for a mean period of 26 ± 7 months. Results. After 6 months, DT had not changed in 80 patients (group 1), whereas it was significantly prolonged (> 125 ms) in the remaining 64 patients (group 2). Baseline Doppler echocardiographic features were similar in the two groups. No changes were found after 6 months in group 1, whereas group 2 showed a slight but significant (p <0.01) reduction in end-systolic volume, an improvement in left ventricular ejection fraction (p <0.01) and a decrease (p <0.01) in the degree of tricuspid regurgitation. During follow-up, 37% of patients in group I experienced cardiac death versus 11% in group 2 (p <0.0005). By Cox model analysis, prolongation of a short DT emerged as the single best predictor of survival (chi-square 15.70). Conclusions. The prolongation of an initially short DT obtained with long-term optimal oral therapy predicts a more favorable outcome in clinically stable patients with CHF.

Original languageEnglish
Pages (from-to)1591-1597
Number of pages7
JournalJournal of the American College of Cardiology
Volume31
Issue number7
DOIs
Publication statusPublished - Jun 1998

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Deceleration
Heart Failure
Therapeutics
Tricuspid Valve Insufficiency
Left Ventricular Dysfunction
Proportional Hazards Models
Stroke Volume
Survival

ASJC Scopus subject areas

  • Nursing(all)

Cite this

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title = "Reversible restrictive left ventricular diastolic filling with optimized oral therapy predicts a more favorable prognosis in patients with chronic heart failure",
abstract = "Objectives. We sought to assess whether in clinically stable patients with chronic heart failure (CHF) the prolongation (i.e., increase) of an initially short (≤125 ms) Doppler transmittal deceleration time (DT) of early filling obtained with long-term optimal oral therapy predicts a more favorable prognosis. Background. It has been recently demonstrated that transmitral early DT is a powerful independent predictor of poor prognosis in patients with left ventricular dysfunction. However, DT may change over time according to loading conditions and medical treatment. Method. One hundred forty-four patients with CHF and a short DT (≤125 ms) underwent repeat Doppler echocardiographic study 6 months after the initial examination, while clinically stable with optimal oral therapy, and were then followed up for a mean period of 26 ± 7 months. Results. After 6 months, DT had not changed in 80 patients (group 1), whereas it was significantly prolonged (> 125 ms) in the remaining 64 patients (group 2). Baseline Doppler echocardiographic features were similar in the two groups. No changes were found after 6 months in group 1, whereas group 2 showed a slight but significant (p <0.01) reduction in end-systolic volume, an improvement in left ventricular ejection fraction (p <0.01) and a decrease (p <0.01) in the degree of tricuspid regurgitation. During follow-up, 37{\%} of patients in group I experienced cardiac death versus 11{\%} in group 2 (p <0.0005). By Cox model analysis, prolongation of a short DT emerged as the single best predictor of survival (chi-square 15.70). Conclusions. The prolongation of an initially short DT obtained with long-term optimal oral therapy predicts a more favorable outcome in clinically stable patients with CHF.",
author = "Temporelli, {Pier L.} and Ugo Corr{\`a} and Alessandro Imparato and Enzo Bosimini and Francesco Scapellato and Pantaleo Giannuzzi",
year = "1998",
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TY - JOUR

T1 - Reversible restrictive left ventricular diastolic filling with optimized oral therapy predicts a more favorable prognosis in patients with chronic heart failure

AU - Temporelli, Pier L.

AU - Corrà, Ugo

AU - Imparato, Alessandro

AU - Bosimini, Enzo

AU - Scapellato, Francesco

AU - Giannuzzi, Pantaleo

PY - 1998/6

Y1 - 1998/6

N2 - Objectives. We sought to assess whether in clinically stable patients with chronic heart failure (CHF) the prolongation (i.e., increase) of an initially short (≤125 ms) Doppler transmittal deceleration time (DT) of early filling obtained with long-term optimal oral therapy predicts a more favorable prognosis. Background. It has been recently demonstrated that transmitral early DT is a powerful independent predictor of poor prognosis in patients with left ventricular dysfunction. However, DT may change over time according to loading conditions and medical treatment. Method. One hundred forty-four patients with CHF and a short DT (≤125 ms) underwent repeat Doppler echocardiographic study 6 months after the initial examination, while clinically stable with optimal oral therapy, and were then followed up for a mean period of 26 ± 7 months. Results. After 6 months, DT had not changed in 80 patients (group 1), whereas it was significantly prolonged (> 125 ms) in the remaining 64 patients (group 2). Baseline Doppler echocardiographic features were similar in the two groups. No changes were found after 6 months in group 1, whereas group 2 showed a slight but significant (p <0.01) reduction in end-systolic volume, an improvement in left ventricular ejection fraction (p <0.01) and a decrease (p <0.01) in the degree of tricuspid regurgitation. During follow-up, 37% of patients in group I experienced cardiac death versus 11% in group 2 (p <0.0005). By Cox model analysis, prolongation of a short DT emerged as the single best predictor of survival (chi-square 15.70). Conclusions. The prolongation of an initially short DT obtained with long-term optimal oral therapy predicts a more favorable outcome in clinically stable patients with CHF.

AB - Objectives. We sought to assess whether in clinically stable patients with chronic heart failure (CHF) the prolongation (i.e., increase) of an initially short (≤125 ms) Doppler transmittal deceleration time (DT) of early filling obtained with long-term optimal oral therapy predicts a more favorable prognosis. Background. It has been recently demonstrated that transmitral early DT is a powerful independent predictor of poor prognosis in patients with left ventricular dysfunction. However, DT may change over time according to loading conditions and medical treatment. Method. One hundred forty-four patients with CHF and a short DT (≤125 ms) underwent repeat Doppler echocardiographic study 6 months after the initial examination, while clinically stable with optimal oral therapy, and were then followed up for a mean period of 26 ± 7 months. Results. After 6 months, DT had not changed in 80 patients (group 1), whereas it was significantly prolonged (> 125 ms) in the remaining 64 patients (group 2). Baseline Doppler echocardiographic features were similar in the two groups. No changes were found after 6 months in group 1, whereas group 2 showed a slight but significant (p <0.01) reduction in end-systolic volume, an improvement in left ventricular ejection fraction (p <0.01) and a decrease (p <0.01) in the degree of tricuspid regurgitation. During follow-up, 37% of patients in group I experienced cardiac death versus 11% in group 2 (p <0.0005). By Cox model analysis, prolongation of a short DT emerged as the single best predictor of survival (chi-square 15.70). Conclusions. The prolongation of an initially short DT obtained with long-term optimal oral therapy predicts a more favorable outcome in clinically stable patients with CHF.

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