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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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slide1

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

slide2

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

slide3

The Failing Heart

Heart Failure

High morbidity and mortality

Increasing incidence

Gentofte

Hospital

Copenhagen City Heart Study

3

slide4

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

methods
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

slide6

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

slide7

Tissue Doppler Imaging

s’

Systole

Diastole

a’

e’

Gentofte

Hospital

Copenhagen City Heart Study

7

slide8

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

slide9

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

slide10

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

slide11

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

slide12

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

slide13

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

slide14

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

slide15

e’/a’

s’

Systole

Diastole

a’

e’/a’

e’

Gentofte

Hospital

Copenhagen City Heart Study

15

slide16

Interdependence of s’, e’,and a’

s’

Systole

Diastole

a’

e’/a’

e’

Gentofte

Hospital

Copenhagen City Heart Study

16

slide17

Interdependence of s’, e’,and a’

s’

e’/s’

Systole

Diastole

a’

e’/a’

e’

Gentofte

Hospital

Copenhagen City Heart Study

17

slide18

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

slide19

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

slide20

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