Serial changes in systolic and diastolic echocardiographic indices as predictors of outcome in patients with decreased left ventricular ejection fraction

Background: Echocardiographic estimation of left ventricular ejection fraction aids in predicting adverse outcomes in coronary artery disease. However, in patients with impaired left ventricular function, further risk stratification is dif- ficult. Methods: A2 yearretrospectivereviewwasperformedtoidentifypatientswithejec- tion fraction � 30%. Echocardiographic measures of systolic and diastolic function were independently performed offline. Outcome information, which included MI, stroke, or death, was obtained. The patient cohort identified those with follow-up having 1) a single echocardiogram and a subset 2) with an initial echocardiogram and a second echocardiogram at greater than one year follow-up. Results: This study included 110 patients, ages 20e94. Mean follow-up time was 29 � 9 months. Ejection fraction did not predict cardiovascular events. LV mass pre- dicted of mortality (p ¼ 0.03). Diastolic indexes of mitral inflow E wave was a signif- icant predictor of outcome (p ¼ 0.05). Impaired diastolic filling grade 2, 3, or 4 showed a 76% event rate. Decreases in ejection fraction at follow-up were seen in those who had an event, with an average decrease in ejection fraction of 17% versus thosewholivedwithnoeventof1%.ChangesinmitralinflowEwaveandchangesinE/ A ratio were both significant predictors of outcome.