Left Ventricular Outflow Indices in Chronic Systolic Heart Failure: Thresholds and Prognostic Value

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-02-19 DOI:10.1111/echo.70109

Frank L. Dini, Valentina Barletta, Piercarlo Ballo, Giovanni Cioffi, Nicola Riccardo Pugliese, Andrea Rossi, Gani Bajraktari, Stefano Ghio, Michael Y. Henein

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Abstract

Background and Aims

The assessment of left ventricular (LV) outflow velocity time integral (LVOT-VTI) has gained favor in the stratification of patients with heart failure (HF). We evaluated the prognostic significance of LVOT-VTI compared with the commonly used indices of LV outflow: cardiac index (CI) and stroke volume index (SVI), their reproducibility and cut-off values.

Methods and Results

A total of 424 outpatients diagnosed with HF and LV systolic dysfunction (LV ejection fraction < 50%) underwent a Doppler echocardiographic examination, including the assessment of CI, SVI, and LVOT-VTI. The Bland–Altman analysis showed LVOT-VTI the most reproducible outflow index. The study follow-up duration was 3.5 years (interquartile range 1.6–6.5), at the end of which there were 94 cardiovascular deaths (29%). Cox regression univariate analysis showed that LVOT-VTI was the most predictive of the study end-point. The ratio of tricuspid annular displacement-to-pulmonary artery systolic pressure (TAPSE/PASP) (p < 0.0001), LVOT-VTI (p = 0.0011), and end-systolic volume index (p = 0.0036) independently predicted the study end-point. At receiver-operating characteristic (ROC) analysis, LVOT-VTI < 12.0 cm had the best sensitivity and specificity for predicting cardiovascular mortality. Reduced LV EF (p = 0.0011), raised BNP levels (p = 0.0053), and high LV filling pressure (p = 0.044) were associated with low LVOT-VTI in multivariate logistic regression analysis. Patients with low LVOT-VTI and TAPSE/PASP < 0.32 mm/mmHg exhibited the worst prognosis on Kaplan–Meier survival curves (p < 0.0001).

Conclusions

A LVOT-VTI < 12.0 cm represents the best predictor of the cardiovascular outcome and proved the most reproducible index of LV forward flow in patients with chronic HF and systolic dysfunction. The combination of impaired LVOT-VTI with TAPSE/PASP showed the worst survival.

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慢性收缩期心力衰竭左心室流出指数：阈值和预后价值

背景与目的评价左室流出流速时间积分（LVOT-VTI）在心衰患者的分层诊断中得到了广泛的应用。我们将LVOT-VTI与常用的左室流出指标：心脏指数（CI）和脑卒中容积指数（SVI）、它们的可重复性和临界值进行比较，评估其预后意义。方法与结果424例诊断为心衰合并左室收缩功能障碍(左室射血分数<；50%)行多普勒超声心动图检查，包括评估CI、SVI和LVOT-VTI。Bland-Altman分析显示LVOT-VTI是最具可重复性的流出指数。研究随访时间为3.5年（四分位数范围1.6-6.5），随访结束时有94例心血管死亡（29%）。Cox单因素回归分析显示，LVOT-VTI对研究终点的预测能力最强。三尖瓣环形位移与肺动脉收缩压之比（TAPSE/PASP） (p <；0.0001)、LVOT-VTI （p = 0.0011）和收缩期末期容积指数（p = 0.0036）独立预测研究终点。在接收机工作特性（ROC）分析中，LVOT-VTI <；12.0 cm对预测心血管死亡率的敏感性和特异性最好。多因素logistic回归分析显示，左室EF降低（p = 0.0011）、BNP升高（p = 0.0053）、左室充注压升高（p = 0.044）与LVOT-VTI降低相关。低LVOT-VTI和TAPSE/PASP患者；Kaplan-Meier生存曲线显示0.32 mm/mmHg预后最差(p <；0.0001)。结论：LVOT-VTI；12.0 cm是心血管预后的最佳预测指标，也是慢性心衰合并收缩功能障碍患者左室前血流的最具可重复性的指标。LVOT-VTI受损合并TAPSE/PASP的生存率最差。

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来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.