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Prognostic value of E/e' in patients with severely decreased left ventricular funct ion
1Kyungpook National University Hospital
*Yoon Jung Park1, Jong Sung Park1, Bo Eun Park1, Se Yong Jang1, Myung Hwan Bae1, Jang Hoon Lee1, Dong Heon Yang1, Hun Sik Park1, Yongkeun Cho1, Shung Chull Chae1
Background: The ratio of early transmitral velocity to tissue Doppler early diastolic velocity (E/e’) is used for estimating pulmonary capillary wedge pressure. However, E/e' may have less sensitive prognostic value in decreased left ventricular (LV) function. We aimed to investigate difference in prog- nostic impact of E/e’ on long term prognosis between decreased and preserved LV function in patients with acute decompensated heart failure (ADHF).
Methods: A total of 836 patients (66.2±14.7 years-old, 442 men) with heart failure between Jan. 2005 and June. 2015 were included. Composite of all-cause mortality and re-hospitalization was recorded during follow-up. Results: During follow-up (22.0 ±18.5 months), 343 (41.0%) events were recorded. In overall patients, E/e’ was an independent prognostic marker for adverse events (hazard ratio [HR] 1.01 [1.00-1.03], p＝0.023) together with age, NYHA class, and serum creatinine. Kaplan-Meier analysis revealed that patients with high E/e’ (E/e’ ＞ 15) exhibited significantly worse prognosis (49.7% vs. 25.7%, p＜0.001) compared to those with low E/e’ (E/e’ ≤ 15) in patients with preserved LV function (LVEF ＞30%), whereas there is no significant difference in prognosis between high and low E/E’ group (45.0% vs. 36.4%, p＝0.144) in patients with decreased LV function (LVEF ≤ 30%). In crude analysis model, E/e’ significantly predicted prognosis in patients with preserved LV function group (HR 1.05 [1.03-1.07], p
＜0.001), whereas E/e’ could not (HR 1.00 [0.99-1.02], p＝0.611) (p for interaction ＜0.001). In adjusted model including age, sex, body mass index, heart rate, hypertension, diabetes, serum sodium, serum creatinine and inotropics use, E/e’ still significantly predicted prognosis in patients with pre- served LV function (HR 1.04 [1.02-1.06], p＜0.001) and it could not in patients with decreased ejection fraction (HR 0.996 [0.98-1.01], p＝0.634).
There was significant interaction in adjusted model (p for interaction ＝0.011). Conclusions: E/e’ significantly predicted long-term outcome in pa- tients with heart failure of preserved LV function, whereas it could not in patients with decreased LV function in ADHF.
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Could Population Based Biennial Health Screening Prevent Cardiovascular disease?
Seonam University Myongji Hospital Cardiology, Cardiovascular Center
*Yong-hwan Jung, Yongsung Suh, Hyun-jin Kim, Hyong-bok Park, Tae-young Choi, Eui-seok Hwang, Deok-kyu Cho
Could Population Based Biennial Health Screening Prevent Cardiovascular disease in General Population without Previous Cardiovascular Disease?
Introduction: There is no data on whether or not biennial national health screening service in Korea could prevent cardiovascular disease in the real clinical field. Method:From national health insurance sample cohort, we enrolled a total of 299,597 survivors without previous cardiovascular disease at 1st Jan. 2010. We dividedall population into irregular (＜2) or regular (＞＝2) screening group according to the number of national health screening service usage from 2006 to 2009. We compared the hard atherosclerotic cardiovascular disease (ASCVD) free survival for 4 years. The definition of hard ASCVD was the composite of myocardial infarction (KCD code I21~23), all stroke (I60~64) and coronary heart disease death (I20~25).
Result:Risk factors such as hypertension (13.3 vs. 12.1% p＜0.001), hyperlipidemia (12.6 vs. 10.6% p＜0.001) and DM (6.6 vs. 6.4%, p＝0.038) had been more frequently detected inregular screening group during screening period. Regular screening group has reduced future hard ASCVD events compared with irregular group after controlling confounding factors including age, gender, household income, residential area and risk factors. (HR 0.746 [95%CI 0.706-0.788], p＜0.001) Conclusions: The regular usage of national health screening service was associated with reduced future hard ASCVD events in general population without previous cardiovascular disease.
