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Several echo-Doppler parameters, particularly the E/e′ ratio, have been explored in the attempt to improve prognostic stratification in chronic heart failure (CHF) patients. In most studies, however, left ventricular filling pressure was not measured and patients with severe impairment of left ventricular function were not considered. The aim of this study was to assess the prognostic value of E/e′ when compared with both traditional echo-Doppler parameters and pulmonary wedge pressure (PWP) in patients with advanced CHF.Right heart catheterization and a two-dimensional echo-Doppler examination were performed at baseline in 49 patients (male: 88%, age: 53 ± 9 years, New York Heart Association class: 2.7 ± 0.7, left ventricular ejection fraction: 29 ± 7%). Traditional pulsed-wave and tissue Doppler velocity parameters (DT, E, SFPVF, E′, and E/e′) were measured. Endpoint of survival analysis was cardiac death or urgent transplantation. During a median follow-up of 47 months (range: 1–58), 18 patients had experienced a major event (cardiac death or urgent transplantation). Both DT and E/e′ were significantly and independently associated with the outcome (the Cox analysis), but the strength of the association was stronger for the latter (P= 0.008 vs. P= 0.03). Moreover, DT became non-significant when adjusted for PWP, whereas E/e′ preserved its prognostic value (P= 0.04). The prognostic value of E′ and PWP was borderline non-significant or clearly non-significant in both univariate and multivariable analyses.Among the echo-Doppler parameters, E/e′ shows the highest predictive value in patients with advanced CHF and provides prognostic information independent of PWP. These results support the use of the feasible and easy obtainable E/e′ ratio as a prognostic indicator in these patients.