Usefulness And Prognostic Value Of The Echocardiographic Multi-Parameter Score (EMPS) In Evaluating Left Ventricular Global Heart Function

PartⅠUsefulness of the Echocardiographic Multi-Parameter Score (EMPS)in Evaluating Left Ventricular Global Heart FunctionObjective:In this study, we established a new index by combining several echocardiographic parameters to quantify heart failure.Methods : We selected 233 consecutive patients who underwent both echocardiographic and plasma B-type natriuretic peptide (BNP) tests within 24 hours after referral for suspected heart failure. The echocardiographic parameters included systolic function, diastolic function, left ventricular chamber remodeling, valvular lesions, systolic pulmonary arterial pressure, and regional wall-motion abnormality. Each factor was scored from 1 to 3 points according to its severity. The total point from these 6 factors is the echocardiographic multi-parameter score (EMPS)Results:The EMPS for 37, 51, 77, and 38 patients from New York Heart Association (NYHA) functional classesⅠ,Ⅱ,Ⅲ, andⅣ, respectively, were 1.24±1.25, 2.98±1.83, 5.96±2.38, and 7.21±1.99, which were significantly different from the mean score of our 30 normal patients (P <0.001). Sensitivity, specificity, and accuracy of an EMPS≥2 for diagnosis of NYHA classesⅡtoⅣwere 93%, 83%, and 89%, respectively. The area under the receiver operating characteristic curve was 0.94 (95% confidence interval, 0.92–0.98; P <0.001). There were significant correlations between logBNP and EMPS (r=0.81, P <0.001) or Tei index (r=0.48, P <0.001). In multilinear regression analysis, EMPS, early/late trans-mitral flow, and peak systolic velocity from tissue Doppler were entered into the model (P <0.001). The standardized regression coefficient (r=0.68) of EMPS was much higher than those of the other 2 factors, which suggests that EMPS is a powerful predictor of BNP levels.Conclusions:EMPS is an objective measurement and comprehensively reflects left ventricular global function and the severity of heart failure. It warrants our further research.PartⅡPrognostic value of the Echocardiographic Multi-Parameter Score (EMPS)in Evaluating Left Ventricular Global Heart FunctionObjective:Based on the importance of echocardiography in stratification of the cardiac prognosis in patients with heart failure (HF), we attempted to identify the prognostic impact of a novel index - echocardiographic multi-parameter score(EMPS) and plasma B-type natriuretic peptide (BNP) concentration.Methods:Of 350 patients admitted with decompensated HF, 181 were included. Among these, 51 patients had ischemic heart disease, 66 patients had hypertensive heart disese, 34 patients had dilated cardiomypathy, 12 patients had hypertrophic cardiomyopathy, 13 patients had vulvalar heart disease and 5 patients had restrictive cardiomyopathy. In all patients, Doppler echocardiographic examinations and measurements of the plasma B-type natriuretic peptide concentration were performed within 24 hours. The echocardiographic parameters included systolic function, diastolic function, left ventricular chamber remodeling, valvular lesions, systolic pulmonary arterial pressure, and regional wall-motion abnormality. Each factor was scored from 1 to 3 points according to its severity. The total point from these 6 factors is the echocardiographic multi-parameter score (EMPS). Patients were followed up for 12 months after discharge. Primary end point for the follow-up was readmission for acute decompensated heart failure or cardiac death.Results:During the follow-up period of 12 months, 90 patients were readmitted with decompensated heart failure and 11 patients were dead. Based on the stepwise multi-variate Cox regression analysis, EMPS (chi-square = 27.37, relative risk = 1.27, p < 0.01) and BNP (chi-square = 7.49, relative risk = 2.02, p < 0.01) were identified as independent predictors of primary endpoints. Based on ROC analysis, the optimal cutoff point of EMPS was 4 (AUC = 0.88, p < 0.01) and that of plasma BNP concentration was≥303.5 pg/ml (AUC = 0.81, p < 0.01). In high-risk patients with EMPS≥4,event-free survival rates were significantly lower in patients with BNP > 303.5 pg/ml(p < 0.001).Conclusions : The complementary assessment of EMPS and plasma BNP concentration may be reliable in identifying the prognosis of patients with HF.