Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent...

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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) 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

Transcript of Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent...

Page 1: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

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

Page 2: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

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)

Rasmus MogelvangThe Copenhagen City Heart Study& Department of Cardiology,Gentofte University HospitalDenmark

Survival

Time

Normal

Abnormal

Page 3: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

The Failing Heart

Heart Failure High morbidity and mortality

Increasing incidence

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Page 4: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

High morbidity and mortality

Increasing incidence

Constant advances in treatmentEarly identification Echocardiography

Tissue Doppler Imaging

The Failing Heart

Heart Failure

versus

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Conventional

Page 5: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

Methods

1,100 persons from the

Copenhagen City Heart Study

Conventional Echocardiography

&

Tissue Doppler Imaging

Mean Follow-up: 5.1 years

http://www.lib.utexas.edu/maps

Copenhagen

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Survivors Non-survivors(n=946) (n=90)

Age - years 58 74 P<0.001

Hypertension – % 42 72 P<0.001

Body Mass Index – kg/m2 25.6 25.7 P=0.91

Heart rate – beats per minute 69 71 P=0.10

Male gender – % 41 44 P=0.58

Diabetes - % 7 13 P<0.04

Ischemic heart disease - % 8 21 P<0.001Severe diastolic dysfunction – % 0.7 1.2 P=0.47Left 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

P-value

Characteristics of the Study Population

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Page 7: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

Tissue Doppler Imaging

Systole Diastole

s’

e’

a’

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Page 8: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

Tissue Doppler Imaging

Systole

s’

Diastole

e’

a’

s’

e’

a’

Survivors Non-survivors

s’ – cm/s 6.1 5.3

a’ – cm/s 6.7 6.3

e’ – cm/s 7.2 5.4

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Page 9: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

Kaplan-Meier Survival PlotsSurvival - %

100

95

90

85

1 2 3 4 5Follow-up in years

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High values

Medium values

Low values

s’

Survival - %100

95

90

85

1 2 3 4 5 6

Medium values

Low values

High values

a’

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Page 10: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

Kaplan-Meier Survival PlotsSurvival - %

100

95

90

85

Survival - %100

95

90

85

1 2 3 4 5Follow-up in years

6

High values

Medium values

Medium values

Low values

Low values

High values

s’

a’8 cm/s vs. 3 cm/s RR 3.0

Multivariate Analysis

RR 1.25 per cm/s; P<0.04

RR 1.25 per cm/s; P<0.001

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Page 11: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

Kaplan-Meier Survival Plot for e’

Survival - %100

95

90

85

1 2 3 4 5Follow-up in years

6

High

Medium

Low

e’

values

values

values

80

Multivariate analysis Relative Risk 1.02 (0.90-1.16); P=0.77

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Page 12: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

40-50 years50-60 years

< 40 years

60-70 years70-80 years > 80 years10

cm/sa’e’s’

8

6

4

2

s’, e’, and a’ according to increasing age

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Page 13: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

40-50 years50-60 years

< 40 years

60-70 years70-80 years > 80 years10

cm/s

8

6

4

2

a’e’s’

s’, e’, and a’ according to increasing age

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Page 14: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

40-50 years50-60 years

< 40 years

60-70 years70-80 years > 80 years

r=-0.4r=-0.8 r=0.3

10

cm/s

8

6

4

2

a’e’s’

s’, e’, and a’ according to increasing age

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e’/a’

Systole Diastole

s’

e’

a’

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e’/a’

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Systole Diastole

s’

e’

a’

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e’/a’

Interdependence of s’, e’, and a’

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Interdependence of s’, e’, and a’

Systole Diastole

s’

e’

a’e’/s’

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e’/a’

Page 18: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

Interdependence of s’, e’, and a’

s’

e’

a’e’/s’

e’/a’

(e’/a’)/s’

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eas-index

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Kaplan-Meier Survival Plot for the eas-index

1 2 3 4 5

Follow-up in years

6

1. tertile

Survival - %

100

95

90

85

2. tertile

3. tertile

Adjusted for age and sexMultivariate analysis 3.tertile vs. 1.tertile

Relative Risk 2.6 (1.4-4.7); P<0.003

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Page 20: Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General.

Tissue Doppler imaging is a powerful prognosticator - even in the presence of a normal conventional echocardiographic examination

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Conclusions

Tissue Doppler imaging is a powerful prognosticator, even in the presence of a normal conventional echocardiographic examination

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Low values of s’ and a’ were significant predictors of death in the general population

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2 Low values of s’ and a’ were significant predictors of death

Combining the information of systolic and diastolic performance strengthens the prognostic value of tissue Doppler imaging

3Combining the information of systolic and diastolic performance strengthens the prognostic value of tissue Doppler imaging

Survival

Time

TDI Normal

TDI Abnormal

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