Improved Diastolic Dysfunction is Associated with Higher Forward Flow and Better Prognosis in Chronic Heart Failure

Abstract Aim. In patients with chronic heart failure (HF), the benefit of repeating the assessment of left ventricle (LV) systolic and diastolic function over time remains uncertain. We assessed the prognostic value of repeated echocardiographic assessment of LV filling pressure (LVFP) and its interaction with cardiac index (CI) in ambulatory patients with chronic HF and reduced ejection fraction (HFrEF)Methods and results. We enrolled 367 patients (age 68±11 years; 22% female) with chronic HFrEF. Patients underwent a clinical and echocardiographic examination at baseline and were re-evaluated after 6±3 months. The 2016 recommendations were used to estimate normal or increased LVFP. CI was evaluated as the product of LV outflow tract area and velocity-time integral multiplied by heart rate and divided by body surface area. After the second examination, patients were followed for a median of 30 months. The study endpoint included all-cause death and hospitalization for worsening HF. Patients who normalized LVFP or showed persistently normal LVFP at the follow-up examination had a significantly lower mortality rate than those with worsening or persistently raised LVFP. After further stratification by CI, patients with elevated LVFP and CI <2.0 L/min/m2 had a further worse outcome than those with elevated LVFP and CI ≥ 2.0 L/min/m2. Multivariate survival analysis confirmed an independent prognostic impact of changes in LVFP, incremental to that of established clinical, laboratory and echocardiographic predictors. Conclusions. Repeated evaluation based on a full diastolic function assessment of LVFP and CI significantly improved risk stratification of stable HFrEF outpatients compared to baseline evaluation.