Left ventricular diastolic function as assessed by transesophageal Doppler recording of pulmonary venous flow has superior prognostic power in dilated cardiomyopathy. A thirteen years follow-up study

Introduction. Pulmonary venous flow transesophageal Doppler recording is a reliable marker of LV diastolic function. However, there are only few data in literature concerning its prognostic role. Furthermore, to date, no study with long-term follow up compared the relative prognostic value of Transmitral and Pulmonary venous flow Doppler recordings. Purpose. Aim of our study was to establish the prognostic impact of LV diastolic function as assessed by Transmitral flow and Pulmonary Venous Flow (PVF) transesophageal Doppler recording in patients with dilated cardiomyopathy (DC). Methods. One hundred and twenty two patients affected by DC with different etiologies were consecutively enrolled in 1995. They were all on optimized therapy. They underwent a TEE Doppler study. Thus PVF was evaluated with the most reliable approach. The following parameters were measured: peak systolic and diastolic PV wave ratio (S/D), E and A mitral wave ratio (E/A), mitral E deceleration time (EDT) and the time difference between PV atrial reversal (Ar) and mitral A wave duration (A). After 15 years the vital status was ascertained by contacting patients or their relatives by phone. Results. During the follow-up period (mean 13,5 +/- 0,8 years) 81 pts (66%) had events (71 died and 10 underwent heart transplantation); no pts were lost to follow-up. LVEF was 28.6±6.5%, LVEDD 65.41±7.1 mm. E/A ratio couldn’t be evaluated in 21 cases because of E and A wave fusion secondary to high heart rate. The multivariate analysis showed that a 2-strata composite variable (diastolic risk) attained by pulmonary waves and A mitral wave (worse category= S/D ratio <1 or S/D>=1 and Ar-A >0) was the best single diastolic variable that predicts hard events in the long term follow-up (hazard ratio = 3,13 with CI = 1,8-5,3, p<0.001, see graph). Other Doppler indexes of diastolic function were not significant at the multivariate analysis. This was due to better prediction of death of the worse category of diastolic risk with respect to the E/A ratio. Conclusion. Our data show that LV diastolic function has important prognostic role in dilated cardiomyopathy when it is best assessed by Pulmonary Venous flow (S/D) combined with A-Ar.