Importance of echocardiography in patients with severe nonischemic heart failure: the second Prospective Randomized Amlodipine Survival Evaluation (PRAISE-2) echocardiographic study.

BACKGROUND Echocardiography is used commonly in clinical practice when caring for patients with heart failure. It is unknown whether the presence of certain findings provides an incremental ability to predict survival beyond the use of baseline clinical findings alone. The second PRAISE-2 echocardiographic study was prospectively designed to identify echocardiographic predictors of survival among patients with nonischemic cardiomyopathy and heart failure and to determine if components of the echocardiographic examination add prognostic information to baseline demographic and clinical information. METHODS One hundred patients participated in the second Prospective Randomized Amlodipine Survival Evaluation Study (PRAISE-2) echocardiographic study; of these, 93 had full and interpretable echocardiographic examinations. Cox proportional hazards modeling was used to assess the relation between various characteristics and survival as well as to assess the incremental prognostic information gained by echocardiography beyond the clinical examination. RESULTS Seven of 10 routine echocardiographic measures were significantly associated with death. These included mitral regurgitation (hazard ratio [HR], 2.31; 95% CI, 1.02, 5.27), left ventricular ejection fraction <20% (HR, 2.59; 95% CI, 1.14, 5.88), restrictive left ventricular filling pattern (HR, 2.37; 95% CI, 1.05, 5.32), and peak D velocity (HR, 1.62; 95% CI, 0.38, 0.87). The only statistically significant clinical predictor of survival was dyspnea at rest. The addition any of several echocardiographic parameters to baseline clinical information significantly improved the ability to predict survival. CONCLUSIONS Several readily available echocardiographic parameters are predictive of death and when added to clinical examination findings significantly improve the ability to determine prognosis among patients with nonischemic cardiomyopathy and heart failure.

[1]  N. Reichek,et al.  Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. , 1986, The American journal of cardiology.

[2]  E. Antman,et al.  ACC/AHA PRACTICE GUIDELINES ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary , 2002 .

[3]  W. Lew,et al.  Evaluation of left ventricular diastolic function. , 1989, Circulation.

[4]  D. Levy,et al.  Determinants of Doppler indexes of left ventricular diastolic function in normal subjects (the Framingham Heart Study). , 1992, The American journal of cardiology.

[5]  D. Cox.  Regression Models and Life-Tables , 1972 .

[6]  L. Goldman,et al.  Predicting outcomes in severe heart failure. , 1997, Circulation.

[7]  H. Ross,et al.  Clinical, Hemodynamic, and Cardiopulmonary Exercise Test Determinants of Survival in Patients Referred for Evaluation of Heart Failure , 1998, Annals of Internal Medicine.

[8]  W. Stevenson,et al.  Predicting death from progressive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. , 1993, The American journal of cardiology.

[9]  M. Enriquez-Sarano,et al.  Determinants of pulmonary venous flow reversal in mitral regurgitation and its usefulness in determining the severity of regurgitation. , 1999, The American journal of cardiology.

[10]  N. Reichek.  Echocardiographic assessment of left ventricular hypertrophy. , 1982, European heart journal.

[11]  K. Bailey,et al.  Use of echocardiography in the management of congestive heart failure in the community. , 1999, Journal of the American College of Cardiology.

[12]  K. Unnebrink,et al.  Prognostic value of Doppler echocardiographic mitral inflow patterns: implications for risk stratification in patients with chronic congestive heart failure. , 2001, Journal of the American College of Cardiology.

[13]  P. Ponikowski,et al.  Echocardiographic determinants of mortality in patients >67 years of age with chronic heart failure. , 2000, The American journal of cardiology.

[14]  M. Drazner,et al.  Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. , 2001, The New England journal of medicine.

[15]  J. Schwartz,et al.  Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. , 1996, Circulation.

[16]  D. Levy,et al.  Survival After the Onset of Congestive Heart Failure in Framingham Heart Study Subjects , 1993, Circulation.

[17]  M. Gheorghiade,et al.  Transthoracic and transesophageal echocardiography in the hemodynamic assessment of patients with congestive heart failure. , 2000, The American journal of cardiology.

[18]  N. Nanda,et al.  Evaluation of valvular regurgitation by color Doppler. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[19]  A. DeMaria,et al.  Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure. , 1994, Journal of the American College of Cardiology.

[20]  A. di Lenarda,et al.  Restrictive left ventricular filling pattern in dilated cardiomyopathy assessed by doppler echocardiography: Clinical, echocardiographic and hemodynamic correlations and prognostic implications , 1993 .

[21]  A J Tajik,et al.  Two-Dimensional and Doppler Echocardiography Alone Can Adequately Define Preoperative Anatomy and Hemodynamic Status before Repair of Complete Atrioventricular Septal Defect in Infants <1 Year Old , 1994, Circulation.

[22]  M. Quiñones,et al.  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. , 2000, Journal of the American College of Cardiology.

[23]  C. G. Blomqvist,et al.  Determination of left ventricular volumes with use of a new nongeometric echocardiographic method: clinical validation and potential application. , 1990, Journal of the American College of Cardiology.

[24]  A. DeMaria,et al.  The hemodynamic basis of diastology , 1999 .

[25]  C. Jaffe,et al.  Left Ventricular Mass Estimation by Echocardiography , 1995, Echocardiography.

[26]  A. Demaria,et al.  Relation of Doppler transmitral flow patterns to functional status in congestive heart failure. , 1996, American heart journal.

[27]  N. Nanda,et al.  Color Doppler assessment of mitral regurgitation with orthogonal planes. , 1987, Circulation.