Reduced stroke distance of the left ventricular outflow tract is independently associated with long-term mortality, in patients hospitalized due to heart failure.

PURPOSE: Reduced blood circulation is an important feature of heart failure, and Doppler stroke distance of the left ventricular outflow tract is a measure of forward stroke volume. Several echocardiographic parameters have known prognostic implications in heart failure, but the prognostic implications of stroke distance in relation to other parameters are insufficiently known. The aim was therefore to test the hypothesis that stroke distance is associated with five-year all-cause mortality, independently of other echocardiography variables, and that stroke distance has added long-term prognostic value. METHODS: A cohort of 350 consecutive elderly patients, over 65 years of age and mean 79·9 ± 7·1 years, hospitalized due to heart failure was studied. Patients with available echocardiography were included and images evaluated. Stroke distance was measured by tracing the systolic velocity time integral (VTI) of the pulsed wave Doppler in the left ventricular outflow tract. Other parameters were also estimated, such as left ventricular ejection fraction (LVEF), left ventricular mass, left atrial volume, early diastolic mitral velocity (E), deceleration time and mitral annulus tissue Doppler diastolic velocity (e') and pulmonary artery systolic pressure (PASP). RESULTS: Five-year all-cause mortality, assessed without missing data, was 67·7%. Multivariate analysis showed that stroke distance, E/e' and PASP were independently associated with mortality, but LVEF was not. CONCLUSIONS: Stroke distance was associated with long-term mortality, independently of other known echocardiographic prognostic factors in elderly patients hospitalized with heart failure. Only when stroke distance was excluded from analysis, LVEF became associated with mortality. Stroke distance had additive prognostic value.

Larger right atrium than left atrium is associated with all-cause mortality in elderly patients with heart failure.

BACKGROUND: While left atrial (LA) enlargement is known as an early sign of left heart disease with prognostic implications in heart failure (HF), the importance of right atrial (RA) enlargement is less well studied, and the prognostic implications of interatrial size comparison are insufficiently understood. The aim of this study was to test the hypothesis that RA area larger than LA area in apical four-chamber view is associated with all-cause mortality in elderly patients with HF independent of left ventricular ejection fraction (LVEF). METHODS: Retrospectively, 289 patients above 65 years hospitalized for HF between April 2007 and April 2008, and who underwent an echocardiogram, were enrolled. All-cause mortality was registered during a follow-up of at least 56 months. Baseline parameters measured were RA area, LA area, LA volume, LVEF, left ventricular mass (LVM), tissue Doppler systolic velocity of right ventricular free wall (SmRV), presence of severe tricuspid regurgitation (TR), tricuspid gradient, central venous pressure, systolic pulmonary artery pressure, as well as some parameters of diastolic function. RESULTS: In univariate analysis RA larger than LA was associated with all-cause mortality (hazard ratio [HR] of 1.88, P<.001). The relation of RA larger than LA to all-cause mortality remained even after adjusting for age, heart rate, LVEF, atrial fibrillation, percutaneous coronary intervention, LVM index, LA volume index, SmRV, and the presence of severe TR (HR: 1.79, P=.04). CONCLUSION: RA larger than LA, independently of LVEF, is associated with all-cause mortality in elderly patients hospitalized due to HF.