Quantitative doppler-echocardiographic imaging and clinical outcomes with left ventricular systolic dysfunction independent effect of pulmonary hypertension

Wayne L. Miller, Douglas W. Mahoney, Maurice E Sarano

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background-Doppler-echocardiography provides quantitative imaging of systolic and diastolic left ventricular (LV) function, functional mitral regurgitation (FMR), and pulmonary hypertension (PH) in patients with LV systolic dysfunction. Whether PH is linked to survival independently of LV features and FMR in symptomatic and asymptomatic patients is unknown. Methods and Results-Patients with LV ejection fraction =40% and quantitative Doppler-echocardiography assessment of FMR and PH were studied. Patients were frequency matched for those with Doppler-echocardiography estimated pulmonary systolic pressure =45 mm Hg (n=692) and those without PH (n=692; pulmonary systolic pressure, <45 mm Hg) for age, sex, LV ejection fraction, and quantified FMR severity and analyzed for long-term survival after diagnosis. During follow-up (median, 8.9 years), 885 deaths (63.5%) occurred, with PH being associated with higher 5-year mortality: 51±2% versus 37±2%, P<0.001. In multivariate analysis, PH demonstrated increased mortality risk independent of age, sex, severity of diastolic and systolic LV dysfunction, FMR, comorbidities, and symptom (hazard ratio, 1.34; 95% confidence limit, 1.17-1.53; P<0.001). Subgroup analysis, stratified by symptoms, degree of FMR, and severity of LV dysfunction, demonstrated that PH was associated with excess mortality in all subgroups. Conclusions-In this large cohort of patients with LV systolic dysfunction, in whom FMR and LV characteristics were quantified and matched between those with and without PH, the presence of PH was an independent factor for excess mortality and not a surrogate for the severity of LV systolic dysfunction or FMR. In asymptomatic or symptomatic patients with or without FMR, PH is a critical marker for poor outcomes.

Original languageEnglish (US)
Pages (from-to)330-336
Number of pages7
JournalCirculation: Cardiovascular Imaging
Volume7
Issue number2
DOIs
StatePublished - 2014

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Left Ventricular Dysfunction
Mitral Valve Insufficiency
Pulmonary Hypertension
Doppler Echocardiography
Mortality
Stroke Volume
Blood Pressure
Lung
Survival
Left Ventricular Function
Comorbidity
Multivariate Analysis

Keywords

  • Hypertension, Pulmonary
  • Outcomes
  • Systolic Dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

@article{59deec046abd4aca94407aa6d400d128,
title = "Quantitative doppler-echocardiographic imaging and clinical outcomes with left ventricular systolic dysfunction independent effect of pulmonary hypertension",
abstract = "Background-Doppler-echocardiography provides quantitative imaging of systolic and diastolic left ventricular (LV) function, functional mitral regurgitation (FMR), and pulmonary hypertension (PH) in patients with LV systolic dysfunction. Whether PH is linked to survival independently of LV features and FMR in symptomatic and asymptomatic patients is unknown. Methods and Results-Patients with LV ejection fraction =40{\%} and quantitative Doppler-echocardiography assessment of FMR and PH were studied. Patients were frequency matched for those with Doppler-echocardiography estimated pulmonary systolic pressure =45 mm Hg (n=692) and those without PH (n=692; pulmonary systolic pressure, <45 mm Hg) for age, sex, LV ejection fraction, and quantified FMR severity and analyzed for long-term survival after diagnosis. During follow-up (median, 8.9 years), 885 deaths (63.5{\%}) occurred, with PH being associated with higher 5-year mortality: 51±2{\%} versus 37±2{\%}, P<0.001. In multivariate analysis, PH demonstrated increased mortality risk independent of age, sex, severity of diastolic and systolic LV dysfunction, FMR, comorbidities, and symptom (hazard ratio, 1.34; 95{\%} confidence limit, 1.17-1.53; P<0.001). Subgroup analysis, stratified by symptoms, degree of FMR, and severity of LV dysfunction, demonstrated that PH was associated with excess mortality in all subgroups. Conclusions-In this large cohort of patients with LV systolic dysfunction, in whom FMR and LV characteristics were quantified and matched between those with and without PH, the presence of PH was an independent factor for excess mortality and not a surrogate for the severity of LV systolic dysfunction or FMR. In asymptomatic or symptomatic patients with or without FMR, PH is a critical marker for poor outcomes.",
keywords = "Hypertension, Pulmonary, Outcomes, Systolic Dysfunction",
author = "Miller, {Wayne L.} and Mahoney, {Douglas W.} and Sarano, {Maurice E}",
year = "2014",
doi = "10.1161/CIRCIMAGING.113.001184",
language = "English (US)",
volume = "7",
pages = "330--336",
journal = "Circulation: Cardiovascular Imaging",
issn = "1941-9651",
publisher = "Lippincott Williams and Wilkins",
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TY - JOUR

T1 - Quantitative doppler-echocardiographic imaging and clinical outcomes with left ventricular systolic dysfunction independent effect of pulmonary hypertension

AU - Miller, Wayne L.

AU - Mahoney, Douglas W.

AU - Sarano, Maurice E

PY - 2014

Y1 - 2014

N2 - Background-Doppler-echocardiography provides quantitative imaging of systolic and diastolic left ventricular (LV) function, functional mitral regurgitation (FMR), and pulmonary hypertension (PH) in patients with LV systolic dysfunction. Whether PH is linked to survival independently of LV features and FMR in symptomatic and asymptomatic patients is unknown. Methods and Results-Patients with LV ejection fraction =40% and quantitative Doppler-echocardiography assessment of FMR and PH were studied. Patients were frequency matched for those with Doppler-echocardiography estimated pulmonary systolic pressure =45 mm Hg (n=692) and those without PH (n=692; pulmonary systolic pressure, <45 mm Hg) for age, sex, LV ejection fraction, and quantified FMR severity and analyzed for long-term survival after diagnosis. During follow-up (median, 8.9 years), 885 deaths (63.5%) occurred, with PH being associated with higher 5-year mortality: 51±2% versus 37±2%, P<0.001. In multivariate analysis, PH demonstrated increased mortality risk independent of age, sex, severity of diastolic and systolic LV dysfunction, FMR, comorbidities, and symptom (hazard ratio, 1.34; 95% confidence limit, 1.17-1.53; P<0.001). Subgroup analysis, stratified by symptoms, degree of FMR, and severity of LV dysfunction, demonstrated that PH was associated with excess mortality in all subgroups. Conclusions-In this large cohort of patients with LV systolic dysfunction, in whom FMR and LV characteristics were quantified and matched between those with and without PH, the presence of PH was an independent factor for excess mortality and not a surrogate for the severity of LV systolic dysfunction or FMR. In asymptomatic or symptomatic patients with or without FMR, PH is a critical marker for poor outcomes.

AB - Background-Doppler-echocardiography provides quantitative imaging of systolic and diastolic left ventricular (LV) function, functional mitral regurgitation (FMR), and pulmonary hypertension (PH) in patients with LV systolic dysfunction. Whether PH is linked to survival independently of LV features and FMR in symptomatic and asymptomatic patients is unknown. Methods and Results-Patients with LV ejection fraction =40% and quantitative Doppler-echocardiography assessment of FMR and PH were studied. Patients were frequency matched for those with Doppler-echocardiography estimated pulmonary systolic pressure =45 mm Hg (n=692) and those without PH (n=692; pulmonary systolic pressure, <45 mm Hg) for age, sex, LV ejection fraction, and quantified FMR severity and analyzed for long-term survival after diagnosis. During follow-up (median, 8.9 years), 885 deaths (63.5%) occurred, with PH being associated with higher 5-year mortality: 51±2% versus 37±2%, P<0.001. In multivariate analysis, PH demonstrated increased mortality risk independent of age, sex, severity of diastolic and systolic LV dysfunction, FMR, comorbidities, and symptom (hazard ratio, 1.34; 95% confidence limit, 1.17-1.53; P<0.001). Subgroup analysis, stratified by symptoms, degree of FMR, and severity of LV dysfunction, demonstrated that PH was associated with excess mortality in all subgroups. Conclusions-In this large cohort of patients with LV systolic dysfunction, in whom FMR and LV characteristics were quantified and matched between those with and without PH, the presence of PH was an independent factor for excess mortality and not a surrogate for the severity of LV systolic dysfunction or FMR. In asymptomatic or symptomatic patients with or without FMR, PH is a critical marker for poor outcomes.

KW - Hypertension, Pulmonary

KW - Outcomes

KW - Systolic Dysfunction

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U2 - 10.1161/CIRCIMAGING.113.001184

DO - 10.1161/CIRCIMAGING.113.001184

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C2 - 24488981

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VL - 7

SP - 330

EP - 336

JO - Circulation: Cardiovascular Imaging

JF - Circulation: Cardiovascular Imaging

SN - 1941-9651

IS - 2

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