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One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fraction

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Abstract

Wave intensity (WI) is a hemodynamic index used to evaluate the interaction between the heart and the arterial system, measured with an echo-Doppler system at the level of the common carotid artery. WI has two peaks: W1 during early systole that represents left ventricular (LV) contractility, and W2 in late systole that is related to the inertia force during isovolumetric relaxation. The aim of this study was to determine whether WI parameters improve the prediction of poor outcome in patients with heart failure and reduced ejection fraction (HFrEF). Sixty-two patients (mean age 69.4 ± 11.5 years) in NYHA class II–III were followed up for 43.5 months. They underwent routine clinical work-up, transthoracic echocardiography and WI measurement. A stratified survival analysis was conducted using the Kaplan–Meier method. During follow-up, 23 patients died from cardiovascular causes. Survivors and non-survivors were similar in age, blood pressure, heart rate and echocardiographic parameters, except for LV end-diastolic volume indexed to body surface area, E/A ratio (higher in non-survivors) and deceleration time (lower in non-survivors). W2 (1950 ± 1006 vs 1117 ± 708 mmHg m/s3, p = 0.001) was significantly lower in non-survivors, whereas W1 (6951 ± 4119 vs 5748 ± 3891 mmHg m/s3, p = NS) was similar. At the end of follow-up, cardiovascular mortality was higher in patients with W1 ≤ 3900 mmHg m/s3 (p = 0.02) and W2 ≤ 1000 mmHg m/s3 (p = 0.0002). Only E/A (cut-off 1.5) was predictive of mortality (p = 0.05). In patients with HFrEF, WI parameters derived from the carotid artery better identified patients with poor prognosis and were significant predictors of cardiovascular mortality.

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References

  1. McMurray JJ, Adamopoulos S, Anker SD, Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology, ESC Committee for Practice Guidelines et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14:803–869

    Article  CAS  PubMed  Google Scholar 

  2. Yancy CW, Jessup M, Bozkurt B, American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 15:e147–e239

    Article  Google Scholar 

  3. Oh JK, Park SJ, Nagueh SF (2011) Established and novel clinical applications of diastolic function assessment by echocardiography. Circ Cardiovasc Imaging 4:444–455

    Article  PubMed  Google Scholar 

  4. Spencer MP, Greiss FC (1962) Dynamics of ventricular ejection. Circ Res 10:274–279

    Article  CAS  PubMed  Google Scholar 

  5. Noble MI (1968) The contribution of blood momentum to left ventricular ejection in the dog. Circ Res 23:663–670

    Article  CAS  PubMed  Google Scholar 

  6. Clark C (1978) Relation between pressure difference across the aortic valve and left ventricular outflow. Cardiovasc Res 12:276–287

    Article  CAS  PubMed  Google Scholar 

  7. Parker KH, Jones CJ (1990) Forward and backward running waves in the arteries: analysis using the method of characteristics. J Biomech Eng 112:322–326

    Article  CAS  PubMed  Google Scholar 

  8. Vriz O, Zito C, di Bello V et al (2014) Non-invasive one-point carotid wave intensity in a large group of healthy subjects: a ventricular–arterial coupling parameter. Heart Vessels. doi:10.1007/s00380-014-0600-x

    PubMed  Google Scholar 

  9. Ohte N, Narita H, Akita S, Kurokawa K, Hayano J, Sugawara M, Kimura G (2002) The mechanism of emergence and clinical significance of apically directed intraventricular flow during isovolumic relaxation. J Am Soc Echocardiogr 15:715–722

    Article  PubMed  Google Scholar 

  10. Niki K, Sugawara M, Chang D et al (2002) A new noninvasive measurement system for wave intensity: evaluation of carotid arterial wave intensity and reproducibility. Heart Vessels 17:12–21

    Article  PubMed  Google Scholar 

  11. Sugawara M, Niki K, Ohte N, Okada T, Harada A (2009) Clinical usefulness of wave intensity analysis. Med Biol Eng Comput 47:197–206

    Article  PubMed  Google Scholar 

  12. Lang RM, Bierig M, Devereux RB, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  13. Devereux RB, Reichek N (1997) Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55:613–618

    Article  Google Scholar 

  14. Dubin J, Wallerson DC, Cody RJ, Devereux RB (1990) Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination. Am Heart J 120:116–123

    Article  CAS  PubMed  Google Scholar 

  15. Sohn DW, Chai IH, Lee DJ et al (1997) Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 30:474–480

    Article  CAS  PubMed  Google Scholar 

  16. Nagueh SF, Appleton CP, Gillebert TC et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133

    Article  PubMed  Google Scholar 

  17. Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. J Am Coll Cardiol 30:8–18

    Article  CAS  PubMed  Google Scholar 

  18. Harada A, Okada T, Niki K, Chang D, Sugawara M (2002) On-line noninvasive one-point measurements of pulse wave velocity. Heart Vessels 17:61–68

    Article  PubMed  Google Scholar 

  19. Ramsey MW, Sugawara M (1997) Arterial wave intensity and ventriculoarterial interaction. Heart Vessels 12(suppl):128–134

    PubMed  Google Scholar 

  20. Prabhu SD (2007) Altered left ventricular–arterial coupling precedes pump dysfunction in early heart failure. Heart Vessels 22:170–177

    Article  PubMed  Google Scholar 

  21. Sugawara M, Uchida K, Kondoh Y et al (1997) Aortic blood momentum–the more the better for the ejecting heart in vivo? Cardiovasc Res 33:433–446

    Article  CAS  PubMed  Google Scholar 

  22. Kawaguchi M, Hay I, Fetics B, Kass DA (2003) Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation 107:714–720

    Article  PubMed  Google Scholar 

  23. Zhang Y, Liu M, Wang M et al (2010) Wave intensity analysis of carotid artery: a noninvasive technique for assessing hemodynamic changes of hyperthyroid patients. J Huazhong Univ Sci Technol Med Sci 30:672–677

    Article  PubMed  Google Scholar 

  24. Magda SL, Ciobanu AO, Florescu M, Vinereanu D (2013) Comparative reproducibility of the noninvasive ultrasound methods for the assessment of vascular function. Heart Vessels 28:143–150

    Article  PubMed  Google Scholar 

  25. Vriz O, Driussi C, La Carrubba S, Di Bello V, Zito C, Carerj S, Antonini-Canterin F (2013) Comparison of sequentially measured Aloka echo-tracking one-point pulse wave velocity with SphygmoCor carotid–femoral pulse wave velocity. SAGE Open Med. doi:10.1177/2050312113507563

    Google Scholar 

  26. Takaya Y, Taniguchi M, Sugawara M, Nobusada S, Kusano K, Akagi T, Ito H (2013) Evaluation of exercise capacity using wave intensity in chronic heart failure with normal ejection fraction. Heart Vessels 28:179–187

    Article  PubMed  Google Scholar 

  27. Li Y, Guo L (2013) Clinical value of carotid wave intensity analysis for differentiating nonobstructive hypertrophic cardiomyopathy from left ventricular hypertrophy secondary to systemic hypertension. J Clin Ultrasound 41:151–157

    Article  PubMed  Google Scholar 

  28. Siniawski H, Lehmkuhl HL, Dandel M et al (2013) Prognostic value of wave intensity in patients awaiting heart transplantation. J Basic Appl Phys 2:95–103

    Article  Google Scholar 

  29. Ho KKL, Anderson KM, Kannel WB, Grossman W, Levy D (1993) Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 88:107–115

    Article  CAS  PubMed  Google Scholar 

  30. Whalley GA, Doughty RN, Gamble GD, Wright SP, Walsh HJ, Muncaster SA, Sharpe N (2002) Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure. J Am Coll Cardiol 39:1787–1795

    Article  PubMed  Google Scholar 

  31. Agir AA, Celikyurt U, Sahin T et al (2014) What is the lowest value of left ventricular baseline ejection fraction that predicts response to cardiac resynchronization therapy? Med Sci Monit 20:1641–1646

    Article  PubMed Central  Google Scholar 

  32. Kutyifa V, Kloppe A, Zareba W et al (2013) The influence of left ventricular ejection fraction on the effectiveness of cardiac resynchronization therapy: MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). J Am Coll Cardiol 61:936–944

    Article  PubMed  Google Scholar 

  33. Quinones MA (2009) Role of echocardiography in predicting onset of heart failure in patients with stable coronary artery disease: is the whole greater than the sum of its parts? JACC Cardiovasc Imaging 2(1):21–23

    Article  PubMed  Google Scholar 

  34. Quiñones MA, Greenberg BH, Kopelen HA et al (2000) Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 35:1237–1244

    Article  PubMed  Google Scholar 

  35. Ghio S, Gavazzi A, Campana C et al (2001) Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol 37:183–188

    Article  CAS  PubMed  Google Scholar 

  36. Osranek M, Seward JB, Buschenreithner B et al (2007) Diastolic function assessment in clinical practice: the value of 2-dimensional echocardiography. Am Heart J 154:130–136

    Article  PubMed  Google Scholar 

  37. Oh JK, Ding ZP, Gersh BJ, Bailey KR, Tajik AJ (1992) Restrictive left ventricular diastolic filling identifies patients with heart failure after acute myocardial infarction. J Am Soc Echocardiogr 5:497–555

    Article  CAS  PubMed  Google Scholar 

  38. Rihal CS, Nishimura RA, Hatle LK, Bailey KR, Tajik AJ (1994) Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy. Relation to symptoms and prognosis. Circulation 90:2772–2779

    Article  CAS  PubMed  Google Scholar 

  39. Xie GY, Berk MR, Smith MD, Gurley JC, DeMaria AN (1994) Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure. J Am Coll Cardiol 24:132–139

    Article  CAS  PubMed  Google Scholar 

  40. Whalley GA, Doughty RN, Gamble GD, Wright SP, Walsh HJ, Muncaster SA, Sharpe N (2002) The mechanism of emergence and clinical significance of apically directed intraventricular flow during isovolumic relaxation. J Am Soc Echocardiogr 15:715–722

    Article  Google Scholar 

  41. Voelkel NF, Quaife RA, Leinwand LA et al (2006) Right ventricular function and failure: a report of a National Heart, Lung, and Blood Institute Working Group on Cellular and Molecular Mechanisms of Right Heart Failure. Circulation 114:1883–1891

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors are indebted to Dr. Stevo Julius for critical review and final approval of the manuscript.

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Authors and Affiliations

  1. Cardiology and Emergency Department, Sant’Antonio Hospital, Via Trento-Trieste, 33038, San Daniele del Friuli, Udine, Italy

    Olga Vriz & Manola Bettio

  2. Cardiology, ARC, S. Maria degli Angeli Hospital, Pordenone, Italy

    Marco Pellegrinet & Francesco Antonini-Canterin

  3. Institute of Cardiology, University of Messina, Messina, Italy

    Concetta Zito & Scipione Carerj

  4. Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy

    Vitantonio di Bello

  5. Department of Translational Medical Sciences, Federico II University, Naples, Italy

    Antonello Cittadini

  6. Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Eduardo Bossone

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  1. Olga Vriz
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Correspondence to Olga Vriz.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Vriz, O., Pellegrinet, M., Zito, C. et al. One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fraction. Int J Cardiovasc Imaging 31, 1369–1378 (2015). https://doi.org/10.1007/s10554-015-0696-9

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