15 Romanian Journal of Cardiology | Vol. 27, No. 1, 2017 ORIGINAL ARTICLE The prognostic value of a new Tissue Doppler parameter in patients with heart failure with reduced ejection fraction Cristian Mornos 1,2 , Simina Crisan 1,2 , Lucian Petrescu 1,2 , Adina Ionac 1,2 , Dragos Cozma 1 Contact address: Simina Crisan, MD, PhD G. Adam 13A, Timisoara, Romania. E-mail: urseanusimina@yahoo.com 1 „Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania 2 Institute of Cardiovascular Diseases, Timisoara, Romania Abstract: Recent data have demonstrated that a new tissue Doppler index, E/(E’×S’), index that includes the ratio between early diastolic transmitral and mitral annulus velocity (E/E’), as well as the systolic mitral annulus velocity (S’), has a good accuracy to predict cardiac death in patients with heart failure (HF). We analyzed the prognostic value of the E/(E’×S’) ratio in patients with heart failure with reduced ejection fraction (HFrEF). Methods – Echocardiographic examination was perfor- med in 166 patients hospitalized with the diagnosis of heart failure with reduced ejection fraction, before discharge as well as one month later. Worsening of E/(E’×S’) was defined as a value greater than the previous value determined at discharge.The primary event consisted of cardiac death or hospital admission due to HF worsening. Results – During follow-up (34±8.8 months) cardiac events were recorded for 113 patients (68%).The optimal cut-off value for E/(E’×S’) ratio was 1.96 with 84% sensitivity and 80% specificity. At discharge, 60 patients (36,2%) presented a value of the E/(E’×S’) index ≤1.96 (group I) and 106 patients (63.8%) encountered a value of the E/(E’×S’) index >1.96 (group II). The composite end point was significantly higher in group II than in group I (95 events, 89.6% versus 18 events, 30%, p<0.001). Patients with an E/(E’×S’) ratio >1.96 at discharge and its worsening after one month presented the worst prognosis (p<0.05). Conclusions – In patients with with heart failure with reduced ejection fraction, a value of the E/(E’×S’) index >1.96 at hospital discharge associated with its worsening after one month is an important predictor for future cardiac events Keywords: Heart failure, hospital readmission, cardiac events, Tissue Doppler imaging. Rezumat: Date recente au demonstrat că un nou index, E/(E’×S’), index ce include atât raportul dintre velocitatea precoce diastolică transmitrală şi cea a inelului mitral (E/E’), precum şi velocitatea sistolică a inelului mitral (S’), are o bună acurateţe în predicţia morţii de cauză cardiacă la pacienţii cu insuficienţă cardiacă. Am analizat valoarea prognostică a raportului E/(E’×S’) la pacienţi cu insuficienţă cardiacă şi fracţie de ejecţie scăzută. Metodă – Examinarea ecocardiografică a fost efectuată la 166 de pacienţi spitalizaţi cu diagnosticul de insuficienţă cardiacă cu fracţie de ejecţie scăzută, atât la externare cât şi la interval de o lună. Scăderea raportului E/(E’×S’) a fost definită ca orice scădere a acestuia faţă de valoarea iniţială. End-point-ul primar a fost reprezentat de decesul de cauză cardiacă sau reinternarea cauzată de agravarea fenomenelor de insuficienţă cardiacă. Rezultate – Pe parcursul perioadei de urmărire (34±8,8 luni) s-au înregistrat evenimente cardiace la 113 pacienţi (68%). Valoarea cutt-off optimă a raportului iniţial E/(E’×S’) în predicţia evenimentelor cardiace a fost de 1,96 (84% senzitivitate, 80% specificitate). La externare, 60 de pacienţi (36,2%) au prezentat o valoare a raportului E/(E’×S’) ≤1.96 (grup I) iar 106 pacienţi (63,8%) au înregistrat o valoare a E/(E’×S’) >1,96 (grup II). End point-ul compozit a fost semnificativ mai mare în grupul II (95 evenimente, 89,6% versus 18 evenimente, 30%, p<0,001). Pacienţii cu raport E/(E’×S’) >1,96 la externare şi scăderea acestuia la o lună au înregistrat cel mai prost prognostic (p<0,05). Concluzii – La pacienţii cu insuficienţă cardiacă cu fracţie de ejecţie scăzută, o valoarea a E/(E’×S’) >1,96 la externare asociată cu scăderea acesteia la interval de o lună este un predictor important pentru apariţia evenimentelor cardiace. Cuvinte cheie: Insuficienţă cardiacă, reinternare în spital, evenimente cardiace, imagistică Doppler tisular. INTRODUCTION Since echocardiography is a very useful technique for the diagnostic evaluation of dyspnoeic patients, Doppler imaging is providing useful information regar- ding the prognosis of patients with heart failure, taking into the fact that the rate of cardiac events after the onset of HF remains high despite recent advances in the management of this condition 1 . Previous studies have demonstrated that a new tissue Doppler index, E/(E’×S’), has a good accuracy