Prognostic Estimation For Patients With Chronic Systolic Heart Failure By Echocardiography:A Long-Term Survival Analysis

Heart failure is the end stage of most cardiovascular diseases.It is characteristiced by high prevalence,low awareness,high readmission rate,high mortality and has become one of the major public health problems in the world.The prognosis of chronic systolic heart failure can be evaluated by many ways.Some parameters of cardiac echocardiography have been applied to those assessment,such as left ventricular ejection fraction(LVEF)and left ventricular end-stage internal diameter(LVED).However,overall understanding among various ultrasonic indicators is still lacking.Some classical parameters such as mitral regurgitation(MR)and tricuspid regurgitation(TR)are still not be known well.Objective:This study was aims to evaluate the long-term prognostic value of traditional echocardiographic indicators in chronic systolic heart failure,and to establish a non-invasive,fast and accurate prognostic evaluation by analyzing multiple classic ultrasonic parameters in a long-term survival analysis,and also to help clinicians to make clinical decisions.Methods:A total of 279 patients(average age 69.37+12.34 years,38.9%women)with chronic systolic heart failure hospitalized in Qianfoshan Hospital were recruited and followed up to 6-7 years in this study.We performed a long-term survival analysis with the end point of all cause mortality.All patients underwent routine echocardiography,recording left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVED),pulmonary artery systolic pressure(PASP),mitral regurgitation(MR),tricuspid regurgitation(TR),pericardial effusion(PE).Cox proportional analysis was conducted to identify the determinant echo parameters.Results:174 patients died during the follow-up period,with an average follow-up time of 44.11+29.43 months,and the overall all-cause mortality rate was 62.37%.LVED,LVEF,MR,PASP,TR,PLE,PE were correlated with adverse outcome in univariate Analysis.LVEF(>34.5 vs.<34.5%)and PASP(>50.5 vs.<50.5 mmHg)had no significant relevant in the multivariate analysis with P>0.05.LVED(>56.5 vs.<56.5 mm),MR(MRO versus MR1,MR 0 versus MR2),TR(TR 0 versus TR1,TR 0 versus TR 2),PLE,PE were independent risk factors for all causes mortality in multivariate analysis.The mortality of severe MR(MR2:EROA/RAA>0.4)was 2.78 times higher than mild MR(MRO:EROA/RAA<0.2)(95%CI 2.144-3.594 p<0.01).The mortality rate of severe TR(TR2:RJA/RAA>41%)was 2.43 times higher than mild TR(TR0:RJA/RAA<19%)(95%CI1.692-3.501 p<0.01).Conclusions:LVED,LVEF,MR,PASP,TR,PLE,PE are the specific indicators for predicting long-term prognostic values in patients with chronic systolic heart failure,and LVED,MR,TR,PLE.PE were independent risk factors of all cause mortality.Although LVEF and PASP are associated with bad prognosis,still not independent risk factors for long term death.This study comprehensively evaluates the value of the classical ultrasonic parameters by traditional two-dimensional ultrasound in a long term survival analysis in patients with chronic systolic heart failure.It is not only to help making clinical strategy but also important for establishing a comprehensive ultrasonic risk assessment system for long-term prognosis.