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European Journal of Heart Failure 2008 10(8):786-792; doi:10.1016/j.ejheart.2008.06.005
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© 2008 European Society of Cardiology

Independence of restrictive filling pattern and LV ejection fraction with mortality in heart failure: An individual patient meta-analysis

Meta-analysis Research Group in Echocardiography (MeRGE) Heart Failure Collaborators*


  Abstract

Background: The Doppler echocardiographic restrictive mitral filling pattern (RFP) is an important prognostic indicator in patients with heart failure (HF), but the interaction between RFP, left ventricular ejection fraction (LVEF) and filling pattern remains uncertain.

Aims: To determine whether the RFP is predictive of mortality independently of LVEF in patients with HF.

Methods: Online databases were searched to identify studies assessing the relationship between prognosis and LV filling pattern in patients with HF. Individual patient data from 18 studies (3540 patients) were extracted and collated at the MeRGE Coordinating Centre (The University of Auckland).

Results: Overall, RFP was associated with higher all-cause mortality than the non-restrictive filling pattern: hazard ratio 2.42 (95% CI 2.06, 2.83). In multivariable analysis the RFP, LVEF, NYHA class and age were independent predictors of mortality. The prevalence of the RFP was inversely related to LVEF but remained a predictor of mortality even in those patients with preserved LVEF.

Conclusions: The restrictive mitral filling pattern is a powerful predictor of mortality, independent of LVEF and age, in patients with HF. Doppler-derived LV filling patterns are an accessible marker from echocardiography that can readily be incorporated in risk stratification of all patients with HF.

Key Words: Restrictive filling pattern • Doppler echocardiography • Heart failure • Prognosis • LV ejection fraction

Received April 15, 2008; Accepted June 10, 2008

* R.N. Doughty, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland, New Zealand. Tel.: +64 9 373 7599x89804; fax: +64 9 3677146. E-mail address: r.doughty{at}auckland.ac.nz


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