Early Improvement in Serial Echocardiographic Studies in Heart Failure Patients Predicts Long Term Survival—A Pilot Study

• Tertiary-care heart failure clinics often follow patients with repeated echocardiography despite a paucity of data on the usefulness of this practice.
• We completed a retrospective study to determine if improvement in a number of echocardiographic parameters predicted survival.
• Early improvement in left ventricular end-systolic dimension, right ventricular function, and mitral regurgitation were independent predictors of 5-year survival.
• Results of this pilot study suggest that serial echocardiography may aid in stratifying patient care.

BackgroundSeveral echocardiographic measures have prognostic value in heart failure (HF). However, no definitive data exist on how changes in these parameters with treatment affect survival in this patient population. We hypothesized that early improvement on echocardiography could predict long-term survival.Methods and ResultsWe conducted a retrospective review of 404 patients seen in the HF clinic from 2002 to 2008 (6.5 years). Patients had one echocardiogram ≤1 year before and another ≥1 month (10 ± 7 months) after treatment onset. We studied changes in standard echocardiographic parameters, including left (LV) and right (RV) ventricular size and/or function (systolic and/or diastolic), valvular (mitral and tricuspid) function, and pulmonary artery pressure. Survival curves and hazard ratios were generated for patients showing improvement on the 2nd echocardiogram versus those who did not. Multivariable analyses were performed adjusting for age, sex, ischemic etiology, and significant baseline echocardiographic parameters. Average follow-up was 2.9 ± 1.5 years. Improvement in LV end-systolic dimension, RV function, and mitral regurgitation were independent predictors of 5-year survival (P < .05) and, importantly, more predictive than baseline values of these parameters alone (higher hazard ratios).ConclusionsEarly echocardiographic improvement is strongly associated with 5-year survival in patients with HF. Serial echocardiography may aid in stratifying patient care.