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Presenter Disclosure Information. Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General Population Results From the Fourth Copenhagen City Heart Study (2002-2007).

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  1. Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General Population Results From the Fourth Copenhagen City Heart Study (2002-2007) Disclosure information The following relationships exist related to this presentation: Rasmus Mogelvang – No disclosures Peter Sogaard – Consulting fees GE Healthcare Modest level Sune A. Pedersen – No disclosures Niels T. Olsen – No disclosures Peter Schnohr – No disclosures Jan S. Jensen – No disclosures Gentofte Hospital Copenhagen City Heart Study

  2. Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General Population Results From the Fourth Copenhagen City Heart Study (2002-2007) Survival Normal Rasmus MogelvangThe Copenhagen City Heart Study& Department of Cardiology,Gentofte University HospitalDenmark Abnormal Time Gentofte Hospital Copenhagen City Heart Study

  3. The Failing Heart Heart Failure High morbidity and mortality Increasing incidence Gentofte Hospital Copenhagen City Heart Study 3

  4. The Failing Heart High morbidity and mortality Heart Failure Increasing incidence Constant advances in treatment Echocardiography Early identification Conventional Tissue Doppler Imaging versus Gentofte Hospital Copenhagen City Heart Study 4

  5. Methods 1,100 persons from the Copenhagen City Heart Study Conventional Echocardiography & Tissue Doppler Imaging Mean Follow-up: 5.1 years Copenhagen http://www.lib.utexas.edu/maps Gentofte Hospital Copenhagen City Heart Study 5

  6. Characteristics of the Study Population Survivors Non-survivors P-value (n=90) (n=946) Age - years 58 74 P<0.001 Male gender – % 41 44 P=0.58 Body Mass Index – kg/m2 25.6 25.7 P=0.91 Heart rate – beats per minute 69 71 P=0.10 Hypertension – % 42 72 P<0.001 Diabetes - % 7 13 P<0.04 Ischemic heart disease - % 8 21 P<0.001 Severe diastolic dysfunction – % 0.7 1.2 P=0.47 Left ventricular ejection fraction <50% - % 0.9 3.5 P<0.05 Left ventricular dilatation - % 5.7 5.5 P=1.00 Left ventricular hypertrophy - % 15 37 P<0.001 Gentofte Hospital Copenhagen City Heart Study 6

  7. Tissue Doppler Imaging s’ Systole Diastole a’ e’ Gentofte Hospital Copenhagen City Heart Study 7

  8. Tissue Doppler Imaging s’ s’ a’ e’ Systole Diastole Non-survivors Survivors a’ s’ – cm/s 6.1 5.3 e’ e’ – cm/s 7.2 5.4 a’ – cm/s 6.7 6.3 Gentofte Hospital Copenhagen City Heart Study 8

  9. Kaplan-Meier Survival Plots s’ Survival - % 100 High values 95 Medium values 90 Low values 85 6 5 4 3 1 2 Follow-up in years a’ Survival - % 100 High values 95 Medium values 90 Low values 85 6 4 5 3 1 2 Gentofte Hospital Copenhagen City Heart Study 9

  10. Kaplan-Meier Survival Plots Multivariate Analysis s’ Survival - % 100 High values 95 Medium values RR 1.25 per cm/s; P<0.04 90 Low values 85 6 5 4 3 1 2 Follow-up in years RR 3.0 8 cm/s vs. 3 cm/s a’ Survival - % 100 High values 95 Medium values RR 1.25 per cm/s; P<0.001 90 Low values 85 Gentofte Hospital Copenhagen City Heart Study 10

  11. Kaplan-Meier Survival Plot for e’ e’ Survival - % 100 High values 95 values Medium 90 85 values Low 80 6 5 4 3 1 2 Follow-up in years Multivariate analysis Relative Risk 1.02 (0.90-1.16); P=0.77 Gentofte Hospital Copenhagen City Heart Study 11

  12. s’, e’,and a’ according to increasing age a’ e’ s’ cm/s 10 8 6 4 2 Gentofte Hospital Copenhagen City Heart Study 12

  13. s’, e’,and a’ according to increasing age a’ e’ s’ cm/s 10 8 6 4 2 Gentofte Hospital Copenhagen City Heart Study 13

  14. s’, e’,and a’ according to increasing age a’ e’ s’ cm/s r=-0.8 10 r=0.3 r=-0.4 8 6 4 2 Gentofte Hospital Copenhagen City Heart Study 14

  15. e’/a’ s’ Systole Diastole a’ e’/a’ e’ Gentofte Hospital Copenhagen City Heart Study 15

  16. Interdependence of s’, e’,and a’ s’ Systole Diastole a’ e’/a’ e’ Gentofte Hospital Copenhagen City Heart Study 16

  17. Interdependence of s’, e’,and a’ s’ e’/s’ Systole Diastole a’ e’/a’ e’ Gentofte Hospital Copenhagen City Heart Study 17

  18. eas-index Interdependence of s’, e’,and a’ s’ (e’/a’)/s’ e’/s’ a’ e’/a’ e’ Gentofte Hospital Copenhagen City Heart Study 18

  19. Kaplan-Meier Survival Plot for the eas-index Survival - % 100 95 1. tertile 2. tertile 90 3. tertile 85 6 5 4 3 1 2 Follow-up in years Multivariate analysis 3.tertile vs. 1.tertile Relative Risk 2.6 (1.4-4.7); P<0.003 Adjusted for age and sex Gentofte Hospital Copenhagen City Heart Study 19

  20. Conclusions Tissue Doppler imaging is a powerful prognosticator, even in the presence of a normal conventional echocardiographic examination 1 Low values of s’ and a’ were significant predictors of death 2 Combining the information of systolic and diastolic performance strengthens the prognostic value of tissue Doppler imaging 3 Tissue Doppler imaging is a powerful prognosticator - even in the presence of a normal conventional echocardiographic examination Low values of s’ and a’ were significant predictors of death in the general population 1 2 Survival Combining the information of systolic and diastolic performance strengthens the prognostic value of tissue Doppler imaging TDI Normal 3 TDI Abnormal Time Gentofte Hospital Copenhagen City Heart Study

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