Echocardiographic Predictors of Mortality in Women With Heart Failure With Reduced Ejection Fraction

Ingrid Josefine Lundorff; Morten Sengeløv; Peter Godsk Jørgensen; Sune Pedersen; Daniel Modin; Niels Eske Bruun; Thomas Fritz-Hansen; Jan Skov Jensen; Tor Biering-Sørensen

doi:10.1161/circimaging.118.008031

Echocardiographic Predictors of Mortality in Women With Heart Failure With Reduced Ejection Fraction

Ingrid Josefine Lundorff, Morten Sengeløv, Peter Godsk Jørgensen, Sune Pedersen, Daniel Modin, Niels Eske Bruun, Thomas Fritz-Hansen, Jan Skov Jensen, Tor Biering-Sørensen

7 Citations (Scopus)

Abstract

BACKGROUND: Previous studies found that global longitudinal strain is a superior predictor of mortality in male patients with heart failure with reduced ejection fraction (EF). This does not apply to women. Our aim was to investigate sex-specific differences in cardiac function and identify echocardiographic predictors of mortality in women with heart failure with reduced EF. METHODS AND RESULTS: Echocardiographic examinations were retrieved from 968 patients with heart failure with reduced EF (26.7% women). Images were analyzed offline, and the end point was all-cause mortality. During follow-up (median: 41 months) 163 patients (16.8 %) died. Women had significantly higher left ventricular (LV) EF (27.1% versus 25.4%, P=0.004), global longitudinal strain (-9.9% versus -8.9%, P<0.001), and global circumferential strain (-10.9% versus -9.7%, P<0.001). Moreover, women displayed higher E/e' (14.4 versus 13.0, P=0.004), LV diastolic elastance (1.16 versus 0.75, P<0.001), and lower e' (6.2 cm/s versus 6.9 cm/s, P<0.001). In women, tricuspid annular plane systolic excursion and LV isovolumetric relaxation time were significant predictors of outcome after multivariable adjustment (tricuspid annular plane systolic excursion: hazard ratio, 1.11; 95% CI, 1.04-1.18; P=0.003 per 1 mm decrease; isovolumetric relaxation time: hazard ratio, 1.07; 95% CI, 1.03-1.10; P=0.001 per 5 ms decrease). LVEF and global longitudinal strain were significant predictors in men (LVEF: hazard ratio, 0.94; 95% CI, 0.90-0.99; P=0.014 per 1% increase; global longitudinal strain: hazard ratio, 1.20; 95% CI, 1.04-1.38; P=0.013 per 1% decrease). CONCLUSIONS: Tricuspid annular plane systolic excursion and LV isovolumetric relaxation time provide prognostic information in women but not in men. Hence, in women with heart failure with reduced EF, right ventricular function, and LV diastolic function seem paramount in predicting mortality, whereas LV systolic function is more important in men.

Original language	English
Article number	e008031
Journal	Circulation: Cardiovascular Imaging
Volume	11
Issue number	11
Number of pages	11
ISSN	1941-9651
DOIs	https://doi.org/10.1161/circimaging.118.008031
Publication status	Published - 2018

Keywords

echocardiography
heart failure
mortality
ventricular dysfunction
women

Access to Document

10.1161/circimaging.118.008031

CIRCIMAGING.118.008031Final published version, 785 KB

https://www.ahajournals.org/doi/pdf/10.1161/CIRCIMAGING.118.008031

Cite this

Lundorff, I. J., Sengeløv, M., Godsk Jørgensen, P., Pedersen, S., Modin, D., Eske Bruun, N., Fritz-Hansen, T., Skov Jensen, J., & Biering-Sørensen, T. (2018). Echocardiographic Predictors of Mortality in Women With Heart Failure With Reduced Ejection Fraction. Circulation: Cardiovascular Imaging, 11(11), Article e008031. https://doi.org/10.1161/circimaging.118.008031

@article{c021278145e140d09e23bdb7a2e09692,

title = "Echocardiographic Predictors of Mortality in Women With Heart Failure With Reduced Ejection Fraction",

abstract = "BACKGROUND: Previous studies found that global longitudinal strain is a superior predictor of mortality in male patients with heart failure with reduced ejection fraction (EF). This does not apply to women. Our aim was to investigate sex-specific differences in cardiac function and identify echocardiographic predictors of mortality in women with heart failure with reduced EF. METHODS AND RESULTS: Echocardiographic examinations were retrieved from 968 patients with heart failure with reduced EF (26.7% women). Images were analyzed offline, and the end point was all-cause mortality. During follow-up (median: 41 months) 163 patients (16.8 %) died. Women had significantly higher left ventricular (LV) EF (27.1% versus 25.4%, P=0.004), global longitudinal strain (-9.9% versus -8.9%, P<0.001), and global circumferential strain (-10.9% versus -9.7%, P<0.001). Moreover, women displayed higher E/e' (14.4 versus 13.0, P=0.004), LV diastolic elastance (1.16 versus 0.75, P<0.001), and lower e' (6.2 cm/s versus 6.9 cm/s, P<0.001). In women, tricuspid annular plane systolic excursion and LV isovolumetric relaxation time were significant predictors of outcome after multivariable adjustment (tricuspid annular plane systolic excursion: hazard ratio, 1.11; 95% CI, 1.04-1.18; P=0.003 per 1 mm decrease; isovolumetric relaxation time: hazard ratio, 1.07; 95% CI, 1.03-1.10; P=0.001 per 5 ms decrease). LVEF and global longitudinal strain were significant predictors in men (LVEF: hazard ratio, 0.94; 95% CI, 0.90-0.99; P=0.014 per 1% increase; global longitudinal strain: hazard ratio, 1.20; 95% CI, 1.04-1.38; P=0.013 per 1% decrease). CONCLUSIONS: Tricuspid annular plane systolic excursion and LV isovolumetric relaxation time provide prognostic information in women but not in men. Hence, in women with heart failure with reduced EF, right ventricular function, and LV diastolic function seem paramount in predicting mortality, whereas LV systolic function is more important in men.",

keywords = "echocardiography, heart failure, mortality, ventricular dysfunction, women",

author = "Lundorff, {Ingrid Josefine} and Morten Sengel{\o}v and {Godsk J{\o}rgensen}, Peter and Sune Pedersen and Daniel Modin and {Eske Bruun}, Niels and Thomas Fritz-Hansen and {Skov Jensen}, Jan and Tor Biering-S{\o}rensen",

year = "2018",

doi = "10.1161/circimaging.118.008031",

language = "English",

volume = "11",

journal = "Circulation: Cardiovascular Imaging",

issn = "1941-9651",

publisher = "Lippincott Williams & Wilkins",

number = "11",

}

TY - JOUR

T1 - Echocardiographic Predictors of Mortality in Women With Heart Failure With Reduced Ejection Fraction

AU - Lundorff, Ingrid Josefine

AU - Sengeløv, Morten

AU - Godsk Jørgensen, Peter

AU - Pedersen, Sune

AU - Modin, Daniel

AU - Eske Bruun, Niels

AU - Fritz-Hansen, Thomas

AU - Skov Jensen, Jan

AU - Biering-Sørensen, Tor

PY - 2018

Y1 - 2018

N2 - BACKGROUND: Previous studies found that global longitudinal strain is a superior predictor of mortality in male patients with heart failure with reduced ejection fraction (EF). This does not apply to women. Our aim was to investigate sex-specific differences in cardiac function and identify echocardiographic predictors of mortality in women with heart failure with reduced EF. METHODS AND RESULTS: Echocardiographic examinations were retrieved from 968 patients with heart failure with reduced EF (26.7% women). Images were analyzed offline, and the end point was all-cause mortality. During follow-up (median: 41 months) 163 patients (16.8 %) died. Women had significantly higher left ventricular (LV) EF (27.1% versus 25.4%, P=0.004), global longitudinal strain (-9.9% versus -8.9%, P<0.001), and global circumferential strain (-10.9% versus -9.7%, P<0.001). Moreover, women displayed higher E/e' (14.4 versus 13.0, P=0.004), LV diastolic elastance (1.16 versus 0.75, P<0.001), and lower e' (6.2 cm/s versus 6.9 cm/s, P<0.001). In women, tricuspid annular plane systolic excursion and LV isovolumetric relaxation time were significant predictors of outcome after multivariable adjustment (tricuspid annular plane systolic excursion: hazard ratio, 1.11; 95% CI, 1.04-1.18; P=0.003 per 1 mm decrease; isovolumetric relaxation time: hazard ratio, 1.07; 95% CI, 1.03-1.10; P=0.001 per 5 ms decrease). LVEF and global longitudinal strain were significant predictors in men (LVEF: hazard ratio, 0.94; 95% CI, 0.90-0.99; P=0.014 per 1% increase; global longitudinal strain: hazard ratio, 1.20; 95% CI, 1.04-1.38; P=0.013 per 1% decrease). CONCLUSIONS: Tricuspid annular plane systolic excursion and LV isovolumetric relaxation time provide prognostic information in women but not in men. Hence, in women with heart failure with reduced EF, right ventricular function, and LV diastolic function seem paramount in predicting mortality, whereas LV systolic function is more important in men.

AB - BACKGROUND: Previous studies found that global longitudinal strain is a superior predictor of mortality in male patients with heart failure with reduced ejection fraction (EF). This does not apply to women. Our aim was to investigate sex-specific differences in cardiac function and identify echocardiographic predictors of mortality in women with heart failure with reduced EF. METHODS AND RESULTS: Echocardiographic examinations were retrieved from 968 patients with heart failure with reduced EF (26.7% women). Images were analyzed offline, and the end point was all-cause mortality. During follow-up (median: 41 months) 163 patients (16.8 %) died. Women had significantly higher left ventricular (LV) EF (27.1% versus 25.4%, P=0.004), global longitudinal strain (-9.9% versus -8.9%, P<0.001), and global circumferential strain (-10.9% versus -9.7%, P<0.001). Moreover, women displayed higher E/e' (14.4 versus 13.0, P=0.004), LV diastolic elastance (1.16 versus 0.75, P<0.001), and lower e' (6.2 cm/s versus 6.9 cm/s, P<0.001). In women, tricuspid annular plane systolic excursion and LV isovolumetric relaxation time were significant predictors of outcome after multivariable adjustment (tricuspid annular plane systolic excursion: hazard ratio, 1.11; 95% CI, 1.04-1.18; P=0.003 per 1 mm decrease; isovolumetric relaxation time: hazard ratio, 1.07; 95% CI, 1.03-1.10; P=0.001 per 5 ms decrease). LVEF and global longitudinal strain were significant predictors in men (LVEF: hazard ratio, 0.94; 95% CI, 0.90-0.99; P=0.014 per 1% increase; global longitudinal strain: hazard ratio, 1.20; 95% CI, 1.04-1.38; P=0.013 per 1% decrease). CONCLUSIONS: Tricuspid annular plane systolic excursion and LV isovolumetric relaxation time provide prognostic information in women but not in men. Hence, in women with heart failure with reduced EF, right ventricular function, and LV diastolic function seem paramount in predicting mortality, whereas LV systolic function is more important in men.

KW - echocardiography

KW - heart failure

KW - mortality

KW - ventricular dysfunction

KW - women

U2 - 10.1161/circimaging.118.008031

DO - 10.1161/circimaging.118.008031

M3 - Journal article

C2 - 30571317

AN - SCOPUS:85058920736

SN - 1941-9651

VL - 11

JO - Circulation: Cardiovascular Imaging

JF - Circulation: Cardiovascular Imaging

IS - 11

M1 - e008031

ER -

Echocardiographic Predictors of Mortality in Women With Heart Failure With Reduced Ejection Fraction

Abstract

Keywords

Access to Document

Fingerprint

Cite this