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

https://doi.org/10.1016/S0735-1097(00)00908-6Get rights and content
Under an Elsevier user license
open archive

Abstract

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 Sharing status I (inotrope-dependent) heart transplant (n = 3) or urgent implantation of a LV assist device (n = 6). Doppler-derived dP/dt (dichotomized 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 ≥ 600; intermediate risk, dP/dt < 600 and −dP/dt ≥ 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.

CONCLUSION

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.

Abbreviations

CHF
congestive heart failure
LV
left ventricular
LVEF
left ventricular ejection fraction
MR
mitral regurgitation
UNOS
United Network for Organ Sharing

Cited by (0)