P383Prognostic value of a new Tissue Doppler index in patients with non-revascularized coronary artery disease

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It has been shown that a value >1.6 for a new Tissue Doppler index, E/(E'×S'), is able to predict a high level of left ventricular (LV) end-diastolic pressure (E = early diastolic transmitral velocity, E' = early diastolic mitral annular velocity and S' = systolic mitral annular velocity). The purpose of our study was to investigate whether E/(E'×S') could be a predictor of cardiac events in patients with non-revascularized coronary artery disease (NCAD).Methods: We determined E/(E'×S') in 74 hospitalized patients with NCAD, in sinus rhythm. The average of the velocities from the septal and lateral mitral annular sites was used. Patients with inadequate echocardiographic images, paced rhythm, significant primary valvular heart disease, coronary revascularization during follow-up, severe pulmonary disease, malignant neoplasia, renal failure, were not included in this group. The primary study end-point was definite as cardiac death or hospital readmission due to myocardial ischemia or heart failure worsening.Results: During the follow-up period (35±11 months) cardiac events occurred in 40 patients (54%): 7 cardiac deaths (9%) and 33 hospital readmissions (44%). Of our patients, 40 (54%) presented E/(E'×S')>1.6 and 34 (46%) presented E/(E'×S')≤1.6. Mean E/(E'×S') was 2.85±0.69 in patients with E/(E'×S')>1.6, while it was 0.99±0.38 in the rest (p<0.001). The E/(E'×S') ratio >1.6 had a sensitivity of 85% and a specificity of 80% to predict cardiac events. Kaplan–Meier analysis (figure 1) showed that the cardiac event-free survival rate during follow-up was significantly higher in the group of patients with E/(E'×S')≤1.6 than in the rest with E/(E'×S')>1.6 (82.3% versus 15%, p<0.001, log-rank).Conclusions: In patients with NCAD, E/(E'×S') ratio >1.6 could be a powerful predictor of cardiac events.

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