Highlights
- •Cases with transmitral E-A overlap are occasionally found in the clinical setting, and its clinical meaning is not well determined.
- •E-A overlap time was related to heart rate and left ventricular function.
- •Patients with E-A overlap as a marker of incomplete relaxation had a significantly high event rate.
ABSTRACT
Background
The overlap time of transmitral flow can be a novel marker of subclinical left ventricular
dysfunction for predicting adverse events in heart failure (HF). We aimed to (1) investigate
the role of overlap time of the E-A wave in association with clinical parameters and
(2) evaluate whether the overlap time could add prognostic information with respect
to other conventional clinical prognosticators in HF.
Methods
We prospectively evaluated 153 patients hospitalized with HF (mean age 68 ± 15 years;
63% male). The primary endpoint was readmission following HF or cardiac death.
Results
During a median period of 25 months, 43 patients were readmitted or died. Overlap
time appeared to be associated with worse outcomes. After adjustment for readmission
scores and ratios of diastolic filling period and cardiac cycle length in a Cox proportional-hazards
model, overlap time was associated with event-free survival, independent of elevated
left atrial pressure based on guidelines. When overlap time was added to the model
based on clinical variables and elevated left atrial pressure, the C-statistic significantly
improved from 0.70 (95% CI: 0.63–0.77) to 0.77 (95% CI: 0.69–0.83, compared) (P = 0.035).
Conclusion
This preliminary study suggested that prolonged overlap time may have potential for
predicting readmission and cardiac mortality risk assessment in patients with HF.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiac FailureAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart disease and stroke statistics–2020 update: a report from the American Heart Association.Circulation. 2020; 141: e139-e596
- Evaluation of 30-day hospital readmission and mortality rates using regression-discontinuity framework.J Am Coll Cardiol. 2019; 74: 219-234
- The clinical application of the ratio of transmitral early filling velocity to early diastolic strain rate: a systematic review and meta-analysis.J Echocardiogr. 2020; 18: 94-104
- Utility of strain imaging in conjunction with heart failure stage classification for heart failure patient management.J Echocardiogr. 2019; 17: 17-24
- Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2016; 29: 277-314
- Updated left ventricular diastolic function recommendations and cardiovascular events in patients with heart failure hospitalization.J Am Soc Echocardiogr. 2019; 32 (1286–97 e2)
- Reliability of updated left ventricular diastolic function recommendations in predicting elevated left ventricular filling pressure and prognosis.Am Heart J. 2017; 189: 28-39
- Clinical utility of the 2016 ASE/EACVI recommendations for the evaluation of left ventricular diastolic function in the stratification of post-discharge prognosis in patients with acute heart failure.Eur Heart J Cardiovasc Imaging. 2019; 20: 1129-1137
- Mean right atrial pressure for estimation of left ventricular filling pressure in patients with normal left ventricular ejection fraction: invasive and noninvasive validation.J Am Soc Echocardiogr. 2018; 31: 799-806
- Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study.J Am Coll Cardiol. 1988; 12: 426-440
- Prognostic importance of a short deceleration time in symptomatic congestive heart failure.Eur J Heart Fail. 2008; 10: 689-695
- How to consider target heart rate in patients with systolic heart failure.ESC Heart Failure. 2020; 7: 3231-3234
- Usefulness of overlapping of the E and A waves of the transmitral flow as a predictor of responders to cardiac resynchronization therapy.Am J Cardiol. 2013; 111: 1613-1618
- JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure: Digest Version.Circ J. 2019; 83: 2084-2184
- A Report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure Consensus Conference.J Card Fail. 2021; (S1071-9164(21)00050-6.)
- Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography.J Am Soc Echocardiogr. 2019; 32: 1-64
- An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure.Circ Cardiovasc Qual Outcomes. 2008; 1: 29-37
- Interval from the onset of transmitral flow to annular velocity is a marker of LV filling pressure.JACC: Cardiovasc Imag. 2013; 6: 528-530
- Novel echocardiographic method to assess left ventricularchamber stiffness and elevated end-diastolic pressure based on time-velocity integral measurements of pulmonary venous and transmitral flows.Eur Heart J Cardiovasc Imag. 2018; 19: 1260-1267
- Heart rate is an important consideration for cardiac imaging of diastolic function.JACC: Cardiovascular Imag. 2016; 9: 756-758
- Consequences of increasing heart rate on deceleration time, the velocity-time integral, and E/A.Am J Cardiol. 2006; 97: 130-136
- Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study.Lancet. 2010; 376: 875-885
- Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial.Lancet. 2010; 376: 886-894
Article info
Publication history
Published online: June 12, 2021
Accepted:
May 18,
2021
Received in revised form:
April 22,
2021
Received:
March 2,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
