Repeat evaluation of diastolic filling pattern after treatment of congestive heart failure in patiente with restrictive diastolic filling: Implication for long-term prognosis

A restrictive diastolic filling pattern predicts the poor prognosis on patients(pts) with congestive heart failure(CHF). However, it is not well known whether a prognosis can be improved by making diastolic filling pattern less restrictive with treatment. We assessed retrospectively long-term prognosis of consecutive 118 pts (77 men and 41 women; mean age 71 ±11 yrs) who had a restrictive diastolic filling pattern by Doppler echo on admission for CHF from Jan. 1 to Dec. 31 in 1993 and had follow-up echo during treatment. The underlying etiologies of CHF were coronary artery disease(61%), dilated cardiomyopathy(27%), valvular heart diseases (11%) and others(7%). History of hypertension was present in 52 pts(46%). In follow-up echo(mean interval 98±88 days), diastolic filling patterns was changed to non-restrictive pattern in 39 pts(NR group: 26 men and 13 women, age 67±13 yrs), and remained restrictive in 79 pts (R. group: 51 men and 28 women, age 74±9 yrs). There was no significant difference in underlying etiologies and treatment modalities between both groups. During mean follow-up of 2.0±1.0 yrs, 59 pts died (9 pts in NR group, 50 pts in R group). Long-term survival by Kaplan-Meier method was significantly different between NR group and R group: 92% vs 75% at 1 yr; 80% vs 26% at 3 yr, respectively (Χ2=21.04, p=0.0001). The survival difference remained statistically significant when adjusted for age and sex(Χ2=16.6, p=0.0001). Conclusions: In pts with CHF, 1) Initial restrictive diastolic filling pattern can be altered to non-restrictive filling pattern by CHF treatment 2) A change on diastolic filling to non-restrictive pattern is associated with improved survival. 3) Repeat evaluation of diastlolic filling by Doppler echo appears to be a useful monitoring tool for treatment of CHF.