VALUE OF dP/dt AND-dP/dt AS SURVIVAL PARAMETERS IN PATIENTS
WITH CONGESTIVE HEART FAILURE
E. Talirević, M. Talirević, N. Nabil and Al-Tawil Dj.
for Cardiac and Rheumatic Diseases1, Clinical Center University
of Sarajevo, General Hospital Sarajevo2, Sarajevo, Bosnia
heart failure represents one of the most frequently encountered
care problems. Especially difficult task is the identification
of patients at highest risk of experience sudden cardiac death,
myocardial infraction or acute pulmonary edema, who could benefit
of extremely aggressive treatment and are potential candidates
for cardiac transplantation. The goal of this study was to analyse
two Doppler parameters of left ventricular systolic and diastolic
function and to determine their predictive value in estimating
survival. Total of 37 (thirty-seven) patients entered the study.
All patients were hospitalised at the Clinic for Cardiac and Rheumatic
Diseases with symptoms of heart failure (NYHA Class III and IV).
Doppler parameters dP/dt and -dP/dt were obtained by an off -line
analysis of mitral regurgitation jet. Average patients' age was
59,8 years, mean ejection fraction (EF) was 24%. With the goal
of comprehensive analysis echocardiographic and laboratory parameters
were obtained from all patients. Primary end point was cardiac
mortality at 30 days. By the study end, thirteen patients died.
Using statistical analysis, three groups with dP/dt and -dP/dt
parameters were formed, each entailing different prognosis; low-risk
group with dP/dt>600 mmhg/s, intermediate-risk group with dP/dt<600
mmHg/s and -dP/dt>450 mmHg/s, and high-risk group with dP/dt<
600 mmHg/s and -dP/dt< 450 mmHg/s. Multivariate analysis of different
parameters showed that these Doppler risk groups, the need for
inotropic support and blood urea nitrogen (BUN) represented the
most useful prognostic parameters.