Highlights
Introduction
Methods
Patient selection
Echocardiography Core lab analysis
Statistical analysis
Results
Study population
Echo Variables | N | Data Distribution |
---|---|---|
E/A ratio | 1511 | 1.00 (0.67, 1.67) |
E velocity (m/s) | 1511 | 0.70 (0.50, 0.90) |
EF (%) | 1498 | 29.0 (24.0, 35.0) |
MR severity (by CFI grade) | 1426 | |
Grade 0 | 404 (28.3%) | |
Grade 1 | 678 (47.6%) | |
Grade 2 | 233 (16.3%) | |
Grade 3 | 78 (5.5%) | |
Grade 4 | 33 (2.3%) | |
RV dysfunction | 1414 | |
Normal | 1069 (77.5%) | |
Mild dysfunction | 181 (12.8%) | |
Moderate dysfunction | 102 (7.2%) | |
Severe dysfunction | 35 (2.5%) | |
Deceleration time (ms) | 1386 | 181.0 (149.0, 221.0) |
LVEDVI (cc/m2) | 1161 | 111.8 (90.5, 134.0) |
LVESVI (cc/m2) | 1161 | 79.1 (60.8, 99.4) |
LA volume index (cc/m2) | 947 | 39.3 (30.8, 48.6) |
Sphericity index | 935 | 0.7 (0.6, 0.7) |
E/e’ ratio | 873 | 15.0 (11.2, 20.0) |
Univariable modeling of prognostic variables with the original dataset
E/A ≤ 0.6 | E/A > 0.6–2.3 | E/A > 2.3 | P value | |
---|---|---|---|---|
No. Patients | 273 | 1010 | 228 | |
Age- yrs. (SD) | 63.9 (9.0) | 60.3 (9.6) | 58.4 (9.2) | < 0.001 |
Female (%) | 50 (18.3) | 163 (16.1) | 20 (8.8) | 0.007 |
Body mass index-m2 (SD) | 27.2 (3.9) | 27.8 (4.8) | 26.7 (4.8) | 0.001 |
Systolic blood pressure-mmHg (SD) | 122.3 (18.2) | 121.7 (17.3) | 115.9 (17.6) | < 0.001 |
Heart rate-bpm (SD) | 71.8 (10.8) | 72.0 (13.5) | 77.4 (16.1) | < 0.001 |
Hemoglobin-g/dL (SD) | 14.0 (1.60) | 13.7 (1.7) | 13.4 (1.9) | 0.001 |
Creatinine-mg/dL (SD) | 1.14 (0.52) | 1.13 (0.56) | 1.18 (0.32) | 0.001 |
Blood urea nitrogen-mg/dL (SD) | 28.7 (18.5) | 27.3 (19.8) | 33.2 (23.5) | 0.001 |
EF-% (SD) | 30.0 (8.2) | 30.1 (8.1) | 26.5 (8.11) | < 0.001 |
LVESVI-cc/m2 (SD) | 80.0 (30.7) | 81.4 (29.8) | 92.3 (31.5) | 0.001 |
Cardiac index-L/min/m2 (SD) | 2.35 (0.70) | 2.37 (0.79) | 2.42 (0.88) | 0.8793 |
E/e’ (SD) | 12.3 (6.2) | 17.0 (8.4) | 26.9 (12.0) | < 0.001 |
Deceleration time-ms (SD) | 243.5 (52.3) | 189.4 (50.3) | 135.8 (27.2) | < 0.001 |
Normal RV function (%) | 224 (88.2) | 776 (83.6) | 96 (43.6) | < 0.001 |
Sphericity index (SD) | 0.67 (0.08) | 0.68 (0.09) | 0.71 (0.08) | < 0.001 |
Beta Blocker (%) | 236 (86.4) | 892 (88.3) | 196 (86.0) | 0.503 |
ACE inhibitor (%) | 219 (80.2) | 826 (81.8) | 188 (82.5) | 0.787 |
Nitrates (%) | 170 (62.3) | 567 (56.1) | 106 (46.3) | 0.002 |
Diuretic (%) | 170 (62.3) | 561 (55.5) | 167 (73.6) | < 0.001 |
Mortality Risk at randomization index | 12.9 (8.5) | 12.1 (8.9) | 14.5 (9.2) | 0.001 |
Univariable modeling of prognostic variables with imputed datasets
Echo Variables | Chi Square | DF | P value | Hazard Ratio (95% CI) |
---|---|---|---|---|
EF (≤ 30%; Δ1%) | 43.1 | 1 | < 0.001 | 0.94 (0.93, 0.96) |
LVESVI (> 65 cc/m2; Δ10 cc/m2) | 41.1 | 1 | < 0.001 | 1.11 (1.07, 1.14) |
E/A ratio | 41.1 | 2 | < 0.001 | |
E/A ≤ 0.6 (Δ 0.1) | 4.9 | 1 | 0.027 | 0.81 (0.68, 0.98) |
E/A 0.6–2.3 (Δ 0.1) | 41.0 | 1 | < 0.001 | 1.05 (1.03, 1.06) |
E/e’ ratio (12–30; Δ1) | 39.5 | 1 | < 0.001 | 1.05 (1.04, 1.07) |
MR severity (CFI grade 0, 1, 2, 3–4) | 37.6 | 1 | < 0.001 | 1.36 (1.23, 1.50) |
E velocity (0.70–0.85; Δ1.0 m/s) | 31.0 | 1 | < 0.001 | 1.04 (1.02, 1.07) |
LA volume index (Δ 10 cc/m2) | 28.1 | 1 | < 0.001 | 1.17 (1.10, 1.24) |
RV dysfunction (qualitative grade) | 27.3 | 1 | < 0.001 | 1.34 (1.20, 1.49) |
Deceleration time (≤190 ms; Δ 10 ms) | 26.0 | 1 | < 0.001 | 0.92 (0.90, 0.95) |
Sphericity index (0.66–0.88; Δ 0.1) | 6.7 | 1 | 0.011 | 1.28 (1.06, 1.55) |
Multivariable modeling of prognostic variables with imputed datasets
Adjusted Effect of ECHO Variable | Adjusted Hazard Ratio (95% CI) | |||
---|---|---|---|---|
Models | Wald Chi-Square | DF | P-value | |
LVESVI (> 65; Δ10 cc/m2) | 44.3 | 1 | < 0.001 | 1.12 (1.08, 1.15) |
LVEF (≤ 30%; Δ1%) | 31.9 | 1 | < 0.001 | 0.95 (0.93, 0.97) |
E/A ratio | 29.1 | 2 | < 0.001 | |
E/A ≤ 0.6 (Δ 0.1) | 0.87 (0.72, 1.05) | |||
E/A 0.6–2.3 (Δ 0.1) | 1.04 (1.03, 1.06) | |||
MR severity (CFI grade 0, 1, 2, and 3–4) | 25.9 | 1 | < 0.001 | 1.31 (1.18, 1.45) |
Deceleration time (≤190 ms, Δ10ms) | 23.4 | 1 | < 0.001 | 0.92 (0.90, 0.95) |
E velocity (0.70–0.85; Δ1.0 m/s) | 19.4 | 1 | < 0.001 | 1.03 (1.02, 1.05) |
E/e’ ratio (12–30; Δ1) | 18.7 | 1 | < 0.001 | 1.04 (1.02, 1.06) |
LA volume index (Δ10 cc/m2) | 16.2 | 1 | < 0.001 | 1.14 (1.07, 1.22) |
RV dysfunction (by quantitative grade) | 16.2 | 1 | < 0.001 | 1.26 (1.13, 1.41) |
Sphericity index (0.66–0.88; Δ 0.1) | 10.2 | 1 | 0.002 | 1.35 (1.12, 1.63) |
Variables | Wald Chi Square | DF | P value | Hazard Ratio (95% CI) |
---|---|---|---|---|
Creatinine (1.0–1.6; Δ1mg/dL) | 30.0 | 1 | < 0.001 | 3.21 (2.11, 4.86) |
LVESVI (> 65; Δ10 cc/m2) | 27.3 | 1 | < 0.001 | 1.09 (1.06, 1.33) |
Age (> 57; Δ10 yr) | 20.3 | 1 | < 0.001 | 1.35 (1.19, 1.55) |
Treatment (CABG/ CABG +SVR vs. MED) | 13.1 | 1 | < 0.001 | 0.71 (0.59, 0.85) |
E/A ratio | 12.4 | 2 | < 0.001 | |
E/A ≤ 0.6 (Δ0.1) | 1.4 | 1 | 0.237 | 0.89 (0.73, 1.08) |
E/A 0.6–2.3 (Δ0.1) | 12.4 | 1 | < 0.001 | 1.03 (1.01, 1.04) |
NYHA (I, II, III, IV) | 7.3 | 1 | 0.007 | 1.18 (1.05, 1.34) |
Diabetes (yes or no) | 6.2 | 1 | 0.013 | 1.27 (1.05, 1.54) |
History of Stroke (yes or no) | 6.2 | 1 | 0.013 | 1.49 (1.09, 2.04) |
MR severity (CFI grade) | 6.1 | 1 | 0.014 | 1.15 (1.03, 1.29) |
History of atrial fibrillation/flutter (yes or no) | 4.2 | 1 | 0.041 | 1.34 (1.01, 1.78) |
Hemoglobin (≤14.3Δ 1 g/dL) | 3.2 | 1 | 0.076 | 0.94 (0.88, 1.01) |