Prognostic importance of tissue velocity imaging during exercise echocardiography in patients with systolic heart failure

Resting echocardiography measurements are poor predictors of exercise capacity and symptoms in heart failure patients. Stress echocardiography may provide additional information and can be expressed using left ventricular ejection fraction (LVEF), or diastolic parameters (E/E’), but LVEF hassome major limitations. Systolic annular velocity (S’) provides a measure of longitudinal systolicfunction which is relatively easy to obtain and show a good relationship with exercise capacity. Theobjective of this study was to investigate the relationship between S’, E/E’ and LVEF obtained during stress echocardiography and both mortality and hospitalisation. A secondary objective was tocompare S’ measured using a simplified 2 wall model. Methods. 80 patients with stable HF underwent exercise stress echocardiography and simultaneous cardiopulmonary exercise testing. Volumetric and Tissue Velocity Imaging (TVI) measurements wereobtained, as was VO2 peak. Results. 11 patients died and 22 required cardiac hospitalisation. S’ at peak exertion was a powerful predictor for death and hospitalisation. Cut off points of 5.3 cm/sec for death and 5.7 cm/sec forhospitalisation provided optimum sensitivity and specificity. Conclusion. This study suggest that in patients with systolic HF, S’ at peak exertion calculated from the averagedspectral TVI systolic velocity of six myocardial segments, or using a simplified measure of two myocardial segments, is a powerful predictor of future events and stronger than LVEF or diastolic velocities at rest or exercise. Results suggest that measuring S’ during exercise echocardiography might have an important role in understanding the likelihood of adverse clinical outcomes in HF patients.