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Long-term outcome of patients with triphasic mitral flow with a mid-diastolic L wave: prognostic role of left atrial volume and N-terminal pro-brain natriuretic peptide

 Sung-Ai Kim  ;  Jungwoo Son  ;  Chi-Young Shim  ;  Eui-Young Choi  ;  Jong-Won Ha 
 International Journal of Cardiovascular Imaging, Vol.33(9) : 1377-1384, 2017 
Journal Title
 International Journal of Cardiovascular Imaging 
Issue Date
Aged ; Atrial Function, Left* ; Biomarkers/blood ; Chi-Square Distribution ; Disease Progression ; Disease-Free Survival ; Echocardiography, Doppler ; Female ; Heart Failure/mortality ; Heart Failure/physiopathology ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Mitral Valve/diagnostic imaging ; Mitral Valve/physiopathology* ; Multivariate Analysis ; Natriuretic Peptide, Brain/blood* ; Peptide Fragments/blood* ; Predictive Value of Tests ; Proportional Hazards Models ; Risk Assessment ; Risk Factors ; Time Factors ; Ventricular Dysfunction, Left/blood ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/mortality ; Ventricular Dysfunction, Left/physiopathology* ; Ventricular Function, Left*
Brain natriuretic peptides ; Diastolic dysfunction ; Echocardiography
A mid-diastolic L wave has been recognized as a marker of advanced left ventricular (LV) diastolic dysfunction. However, its prognostic implication is unclear. This study assessed long-term prognosis and independent predictors of adverse outcomes in patients with a mid-diastolic L wave. A total of 144 consecutive patients (mean age 63 ± 12 years, 88 female) with a mid-diastolic L wave of ≥0.2 m/s and in sinus rhythm were identified. Patients with significant valvular heart disease, low LV ejection fraction and arrhythmias were excluded. Subjects were followed up for cardiovascular (CV) mortality and hospitalization for heart failure (HF). During follow-up for a median of 44 months (1-76), CV deaths and hospitalization for HF occurred in 41 (28%) patients. In multivariate Cox analysis, age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.02-1.11; p = 0.001), log N-terminal pro-brain natriuretic peptide (NT-proBNP)(HR 3.81; 95% CI 1.78-8.15; p = 0.001), and left atrial volume index (HR 1.02; 95% CI 1.01-1.04; p = 0.019) were independent predictors of adverse outcomes in patients with a mid-diastolic L wave. In a stepwise model, NT-proBNP showed an incremental prognostic value for prediction of adverse outcomes when added to the clinical and echocardiographic parameters (Chi square from 30.1 to 41.1, p < 0.001). Patients with a mid-diastolic L wave and clinical, biochemical, and echocardiographic evidence of advanced diastolic dysfunction showed poor long-term clinical outcome.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
심지영(Shim, Chi Young) ORCID logo https://orcid.org/0000-0002-6136-0136
최의영(Choi, Eui Young) ORCID logo https://orcid.org/0000-0003-3732-0190
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
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