Prognostic values of the diastolic index as a marker of chronic heart failure with preserved left ventricular ejection fraction

Abstract

Chronic heart failure (CHF) remains the leading cardiovascular disease worldwide. The prevalence of CHF with preserved ejection fraction (HFpEF) among other CHF phenotypes continues to rise. Despite a large number of studies focused on diagnosing this CHF phenotype, information on additional parameters for the verification of this disease phenotype are accumulating, and their prognostic values remain to be fully addressed. One such echocardiographic marker is the diastolic index that has proven its prognostic value in diagnosing HFpEF in the Japanese population. However, questions have been raised over the possibility of applying this parameter in the European population.

Aim. To prove the diagnostic and prognostic value of the diastolic index as an additional criterion for the HFpEF phenotyping in the European population.

Materials and methods. The study enrolled 88 patients (men – 46.6 % (n = 41); women – 53.4 % (n = 47)) with CHF of ischemic origin, stage II A–B, NYHA class II–IV. The patients were divided into two groups depending on heart rhythm disorder – 67 % (n = 59) with sinus rhythm and 33 % (n = 29) with atrial fibrillation (AF). Groups of patients were comparable in age (p = 0.483), height (p = 0.345), weight (p = 0.317), body surface area (p = 0.153). Doppler echocardiography was routinely performed on an Esaote MyLab Eight device (Italy). Blood pressure was measured with an automatic tonometer before each echocardiographic examination. The diastolic index was calculated according to the formula: Ed/Ea = (E/e’)/(0.9 × systolic blood pressure).

Results. The median follow-up of HFpEF was 1,200 days. During the observation period, 11 endpoints were registered, which amounted to 12.5 %. Analysis of the end point incidence rate depending on the presence of rhythm disturbances has not revealed a significant difference between the studied groups of patients: 13.56 % (8/51) in patients with sinus rhythm vs. 10.34 % (3/26) in patients with AF; log-rank test (p = 0.90060). No significant difference in end points has been found depending on sex between the studied groups: 9.3 % (4/43) in women vs. 20.6 % (7/34) in men; log-rank test (p = 0.65064). An increase in the diastolic index Ed/Ea over 0.0769 was associated with a 1.9-fold increase in the relative risk of adverse cardiovascular events in CHF patients with sinus rhythm (p = 0.0054) in contrast to CHF patients with AF. At the same time, an increase in the Ed/Ea parameter was not associated with an increase in the relative risk of adverse cardiovascular events in CHF patients with AF (p = 0.3466).

Conclusions. The index of diastolic elasticity Ed/Ea has demonstrated its prognostic value in the European population of elderly (over 70 years old) patients with HFpEF. An increase in the diastolic index over 0.0769 units was associated with a significant increase in the relative risk of adverse cardiovascular events by 1.9 times in HF patients with sinus rhythm. The diastolic index Ed/Ea has not confirmed its prognostic value in CHF patients with AF.