Systolic aortic regurgitation in rheumatic carditis: Mechanistic insight by Doppler echocardiography

Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure

AIMS

Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF.

METHODS AND RESULTS

According to recent 10 year echocardiographic database of E-Da Hospital, 533 patients admitted for first systolic heart failure (HF) and left ventricular ejection fraction <35% were under investigation. Systolic PR was defined as the presence of pulmonary backward flow persistent after QRS in electrocardiogram. Isovolumic contraction/relaxation time and myocardial performance index were derived by tissue Doppler imaging. Right ventricular (RV) function was assessed by RV fractional area change. Estimated pulmonary vascular resistance (PVR) was assessed by the ratio of peak tricuspid regurgitation velocity to the RV outflow tract time-velocity integral. The factors associated with systolic PR were assessed by multivariate logistic regression. Cox proportional regression analyses were used to estimate the impact of cardiovascular events including HF rehospitalization and cardiovascular death. For estimated prevalence of 5480 control subjects, echocardiographic screens in those with normal left ventricular ejection fraction were performed. Of 533 systolic HF cases, 143 (26.8%) had systolic PR during indexed hospitalization. Among 143 cases, 86% systolic PR disappeared during late follow-up. In control subjects, 0.3% (18/5480) had systolic PR. Systolic PR correlated to RV dysfunction, estimated PVR, E/e', sign of low cardiac output, and pulmonary oedema. Systolic PR was associated independently with further cardiovascular events (hazard ratio 2.266, 95% confidence interval 1.682-3.089, P < 0.0001) including cardiovascular death and HF rehospitalization.

CONCLUSIONS

Systolic PR is not uncommon in systolic HF and is associated with high PVR and RV dysfunction. Systolic PR significantly impacts cardiovascular outcome.

Systolic aortic regurgitation predicts all-cause mortality and hospitalization in outpatients with heart failure and preserved ejection fraction

OBJECTIVE:

Systolic aortic regurgitation (SAR) is considered to be a specific sign of heart failure (HF). However, the prevalence and importance of SAR in patients with HF and preserved ejection fraction (HFpEF) are unknown. Therefore, we sought to examine the prevalence of SAR in HFpEF outpatients and its association with all-cause mortality and/or cardiovascular hospitalizations during a 1-year follow-up.

METHODS:

We enrolled 301 consecutive outpatients with HFpEF (mean age of 67.3±9.6 years, 53.5% women) and prospectively followed up for one year. Demographic, clinical, echocardiographic, and laboratory data were obtained at study entry. The composite endpoint of this study was all-cause mortality or HF-related hospitalizations in one year.

RESULTS:

SAR was noted in 30 (9.9%) of the patients, and 38 patients (12.6%) reached the primary endpoint. The primary composite endpoint in one year was higher for the patients with SAR (26.3%) compared to the patients without SAR (7.6%, p<0.001). After adjusting for important covariates, SAR remained independently associated with primary outcome (OR 2.315; 95% CI 1.188–5.477; p=0.008).

CONCLUSION:

To our knowledge, this is the first study to demonstrate that the presence of SAR is associated with adverse events in patients with HFpEF.