Different prognostic impact of the tissue Doppler-derived E/e′ ratio on mortality in Chagas cardiomyopathy patients with heart failure

BACKGROUND: Risk assessment of Chagas cardiomyopathy patients is essential for clinical decision making. The ratio of the ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/e') is a powerful predictor of adverse outcome in patients with heart failure. However, its prognostic value remains to be established in the setting of Chagas cardiomyopathy. This study investigated the effect of E/e' on mortality according to different degrees of left ventricular (LV) systolic function in patients with Chagas cardiomyopathy. METHODS: The study prospectively enrolled 232 patients (143 men) with Chagas cardiomyopathy (mean age, 48 +/- 12 years). End points were death or cardiac transplantation. RESULTS: During a mean follow-up of 3.4 years, 107 patients had an adverse cardiac event, with an overall events rate of 13.2/year. Cox proportional hazards model was used with New York Heart Association functional class, LV ejection fraction, right ventricular function, indexed left atrial volume, E/e' ratio, and the statistical interaction term between E/e' ratio and LV ejection fraction. The effect of E/e' ratio on mortality depended on the degree of LV systolic dysfunction. An increasing E/e' ratio was a strong predictor of outcome in patients with mild to moderate LV dysfunction but was inversely associated with mortality in patients with severe systolic dysfunction. CONCLUSION: This study demonstrated the role of the interaction between LV ejection fraction and E/e' ratio in predicting prognosis in Chagas cardiomyopathy patients. The E/e' ratio had a stronger prognostic value in patients with mild and moderate LV dysfunction and was inversely associated with mortality in patients with advanced systolic heart failure. J Heart Lung Transplant 2012;31:634-41 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.