Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort
Abstract Background Left ventricular outflow tract velocity time integral (LVOT VTI) is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure pat...
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| Format: | Article |
| Language: | English |
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BMC
2017-07-01
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| Series: | Cardiovascular Ultrasound |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12947-017-0109-4 |
| _version_ | 1818142920434253824 |
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| author | Christina Tan David Rubenson Ajay Srivastava Rajeev Mohan Michael R. Smith Kristen Billick Samuel Bardarian J. Thomas Heywood |
| author_facet | Christina Tan David Rubenson Ajay Srivastava Rajeev Mohan Michael R. Smith Kristen Billick Samuel Bardarian J. Thomas Heywood |
| author_sort | Christina Tan |
| collection | DOAJ |
| description | Abstract Background Left ventricular outflow tract velocity time integral (LVOT VTI) is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure patients at highest risk for mortality. Methods Patients with heart failure and extremely low LVOT VTI were identified from a single-center database. Baseline characteristics and heart failure related clinical outcomes (death, LVAD) were obtained at 12 months. Correlation between clinical endpoints and the following variables were analyzed: ejection fraction (EF), pulmonary artery systolic pressure (PASP), NYHA class, renal function, Doppler cardiac output (CO), and LVOT VTI. Results Study cohort consisted of 100 patients. At the 12-month follow up period, 30 events (28 deaths, 2 LVADs) were identified. Occurrence of death and LVAD implantation was statistically associated with a lower LVOT VTI (p = 0.039) but not EF (p = 0.169) or CO (p = 0.217). In multivariate analysis, LVOT VTI (p = 0.003) remained statistically significant, other significant variables were age (p = 0.033) and PASP (p = 0.022). Survival analysis by LVOT VTI tertile demonstrated an unadjusted hazard ratio of 4.755 (CI 1.576-14.348, p = 0.006) for combined LVAD and mortality at one year. Conclusions Extremely low LVOT VTI strongly predicts adverse outcomes and identifies patients who may benefit most from advanced heart failure therapies. |
| first_indexed | 2024-12-11T11:23:26Z |
| format | Article |
| id | doaj.art-b178703aef64408d8297020d8fc9edc5 |
| institution | Directory Open Access Journal |
| issn | 1476-7120 |
| language | English |
| last_indexed | 2024-12-11T11:23:26Z |
| publishDate | 2017-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Ultrasound |
| spelling | doaj.art-b178703aef64408d8297020d8fc9edc52022-12-22T01:09:04ZengBMCCardiovascular Ultrasound1476-71202017-07-011511810.1186/s12947-017-0109-4Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohortChristina Tan0David Rubenson1Ajay Srivastava2Rajeev Mohan3Michael R. Smith4Kristen Billick5Samuel Bardarian6J. Thomas Heywood7Fellow, Scripps Clinic CardiologyFellow, Scripps Clinic CardiologyFellow, Scripps Clinic CardiologyFellow, Scripps Clinic CardiologyFellow, Scripps Clinic CardiologyFellow, Scripps Clinic CardiologyFellow, Scripps Clinic CardiologyFellow, Scripps Clinic CardiologyAbstract Background Left ventricular outflow tract velocity time integral (LVOT VTI) is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure patients at highest risk for mortality. Methods Patients with heart failure and extremely low LVOT VTI were identified from a single-center database. Baseline characteristics and heart failure related clinical outcomes (death, LVAD) were obtained at 12 months. Correlation between clinical endpoints and the following variables were analyzed: ejection fraction (EF), pulmonary artery systolic pressure (PASP), NYHA class, renal function, Doppler cardiac output (CO), and LVOT VTI. Results Study cohort consisted of 100 patients. At the 12-month follow up period, 30 events (28 deaths, 2 LVADs) were identified. Occurrence of death and LVAD implantation was statistically associated with a lower LVOT VTI (p = 0.039) but not EF (p = 0.169) or CO (p = 0.217). In multivariate analysis, LVOT VTI (p = 0.003) remained statistically significant, other significant variables were age (p = 0.033) and PASP (p = 0.022). Survival analysis by LVOT VTI tertile demonstrated an unadjusted hazard ratio of 4.755 (CI 1.576-14.348, p = 0.006) for combined LVAD and mortality at one year. Conclusions Extremely low LVOT VTI strongly predicts adverse outcomes and identifies patients who may benefit most from advanced heart failure therapies.http://link.springer.com/article/10.1186/s12947-017-0109-4Congestive heart failureVelocity time integralTime velocity integralEchocardiography |
| spellingShingle | Christina Tan David Rubenson Ajay Srivastava Rajeev Mohan Michael R. Smith Kristen Billick Samuel Bardarian J. Thomas Heywood Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort Cardiovascular Ultrasound Congestive heart failure Velocity time integral Time velocity integral Echocardiography |
| title | Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort |
| title_full | Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort |
| title_fullStr | Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort |
| title_full_unstemmed | Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort |
| title_short | Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort |
| title_sort | left ventricular outflow tract velocity time integral outperforms ejection fraction and doppler derived cardiac output for predicting outcomes in a select advanced heart failure cohort |
| topic | Congestive heart failure Velocity time integral Time velocity integral Echocardiography |
| url | http://link.springer.com/article/10.1186/s12947-017-0109-4 |
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