Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohortReport as inadecuate




Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort - Download this document for free, or read online. Document in PDF available to download.

Cardiovascular Ultrasound

, 15:18

First Online: 03 July 2017Received: 23 February 2017Accepted: 14 June 2017

Abstract

BackgroundLeft ventricular outflow tract velocity time integral LVOT VTI is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure patients at highest risk for mortality.

MethodsPatients with heart failure and extremely low LVOT VTI were identified from a single-center database. Baseline characteristics and heart failure related clinical outcomes death, LVAD were obtained at 12 months. Correlation between clinical endpoints and the following variables were analyzed: ejection fraction EF, pulmonary artery systolic pressure PASP, NYHA class, renal function, Doppler cardiac output CO, and LVOT VTI.

ResultsStudy cohort consisted of 100 patients. At the 12-month follow up period, 30 events 28 deaths, 2 LVADs were identified. Occurrence of death and LVAD implantation was statistically associated with a lower LVOT VTI p = 0.039 but not EF p = 0.169 or CO p = 0.217. In multivariate analysis, LVOT VTI p = 0.003 remained statistically significant, other significant variables were age p = 0.033 and PASP p = 0.022. Survival analysis by LVOT VTI tertile demonstrated an unadjusted hazard ratio of 4.755 CI 1.576-14.348, p = 0.006 for combined LVAD and mortality at one year.

ConclusionsExtremely low LVOT VTI strongly predicts adverse outcomes and identifies patients who may benefit most from advanced heart failure therapies.

KeywordsCongestive heart failure Velocity time integral Time velocity integral Echocardiography AbbreviationsCI95% confidence interval

CODoppler derived cardiac output

EFEjection fraction

EMRElectronic medical record

GFRGlomerular filtration rate

HRHazard ratio

HRHeart rate

LVADLeft ventricular assist device

LVOT VTILeft ventricular outflow tract velocity time integral

NYHA classNew York Heart Association class

PASPPulmonary artery systolic pressure,

SVStroke volume

TTETransthoracic echocardiogram

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Author: Christina Tan - David Rubenson - Ajay Srivastava - Rajeev Mohan - Michael R. Smith - Kristen Billick - Samuel Bardarian -

Source: https://link.springer.com/article/10.1186/s12947-017-0109-4







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