Usefulness of Doppler Echocardiographic Left Ventricular Diastolic Function and Peak Exercise Oxygen Consumption to Predict Cardiovascular Outcomes in Patients with Systolic Heart Failure (From HF-ACTION)

摘要

HF-ACTION was a multicenter, randomized, controlled trial designed to examine the safety and efficacy of aerobic exercise training versus usual care in 2,331 patients with systolic heart failure (HF). In HF-ACTION patients with resting transthoracic echocardiographic (echo) measurements, we examined predictive value of 8 echo-Doppler measurements—left ventricular (LV) diastolic dimension, mass, systolic (ejection fraction) and diastolic function (mitral valve [MV] peak early diastolic-to-peak late diastolic [E/A], peak MV early diastolic velocity-to-tissue Doppler peak early diastolic myocardial velocity [E/E’] ratios, and deceleration time), left atrial (LA) dimension, and mitral regurgitation severity (MR)—for primary endpoint of all-cause death or hospitalization and secondary endpoint of cardiovascular disease (CVD) death or HF hospitalization. We also compared prognostic value of echo variables versus peak oxygen consumption (VO2). MV E/A and E/E’ ratios were more powerful independent predictors of clinical endpoints than was LV ejection fraction (LVEF), but less powerful than peak VO2. In multivariate analyses for predicting primary endpoint, adding E/A ratio to a basic demographic/clinical model increased C-index from 0.61 to 0.62, compared with 0.64 after adding peak VO2. For secondary endpoint, 6 echo variables, but not LVEF or LA dimension, provided independent predictive power over basic model. Addition of E/E’ or E/A to the basic model increased C-index from 0.70 to 0.72 and 0.73, respectively (all p <0.0001). Simultaneously adding E/A and peak VO2 to basic model increased C-index to 0.75 (p <0.0005). No echo variable was significantly related to 0-to-3 month change in exercise peak VO2. In conclusion, addition of echo LV diastolic function variables improves prognostic value of a basic demographic/clinical model for CVD outcomes.