Importance of Echocardiography in Patients With Severe HF
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.
Heart failure is a major public health problem in the United States. While the number of hospitalizations and deaths continues to rise, properly allocating available therapies such as heart transplantation and mechanical support devices remains difficult. Because of the finite supply of available donors, the cardiac transplant system has reached a state of "dynamic equilibrium," with waiting times and mortality rates before transplantation increasing. These factors underscore the importance of identifying easily measurable indices of prognosis to aid clinical decision-making in patients with left ventricular (LV) systolic dysfunction and heart failure. This is particularly true in patients with heart failure of a nonischemic cause, since this group is often underrepresented in heart failure studies.
Echocardiography is a useful diagnostic test in evaluating patients with heart failure and is a focus in the early treatment of patients, as outlined by the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Although several investigators have demonstrated that the echocardiographic examination provides prognostic information in patients with heart failure, these studies have focused primarily on patients with ischemic heart disease. In addition, these studies have not formally examined the incremental ability of echocardiography to predict survival relative to the information gained from the clinical history and physical examination. Clinicians often need to utilize clinical and echocardiographic information simultaneously to formulate an individual patient's plan of care, yet there is little guidance on how to incorporate echocardiographic data with clinical information.
The second Prospective Randomized Amlodipine Survival Evaluation (PRAISE-2) echocardiographic study was prospectively designed to identify echocardiographic predictors of survival in patients with nonischemic cardiomyopathy and to determine if components of the echocardiographic examination add prognostic information to baseline clinical information.
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.
Heart failure is a major public health problem in the United States. While the number of hospitalizations and deaths continues to rise, properly allocating available therapies such as heart transplantation and mechanical support devices remains difficult. Because of the finite supply of available donors, the cardiac transplant system has reached a state of "dynamic equilibrium," with waiting times and mortality rates before transplantation increasing. These factors underscore the importance of identifying easily measurable indices of prognosis to aid clinical decision-making in patients with left ventricular (LV) systolic dysfunction and heart failure. This is particularly true in patients with heart failure of a nonischemic cause, since this group is often underrepresented in heart failure studies.
Echocardiography is a useful diagnostic test in evaluating patients with heart failure and is a focus in the early treatment of patients, as outlined by the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Although several investigators have demonstrated that the echocardiographic examination provides prognostic information in patients with heart failure, these studies have focused primarily on patients with ischemic heart disease. In addition, these studies have not formally examined the incremental ability of echocardiography to predict survival relative to the information gained from the clinical history and physical examination. Clinicians often need to utilize clinical and echocardiographic information simultaneously to formulate an individual patient's plan of care, yet there is little guidance on how to incorporate echocardiographic data with clinical information.
The second Prospective Randomized Amlodipine Survival Evaluation (PRAISE-2) echocardiographic study was prospectively designed to identify echocardiographic predictors of survival in patients with nonischemic cardiomyopathy and to determine if components of the echocardiographic examination add prognostic information to baseline clinical information.
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