Influence of Left Ventricular Symptoms and Survival Decreased Left Ventricular

Diastolic Filling on in Patients with Systolic Function

Ian P. Clements, MD, Manuel L. Brown, MD, Alan R. Zinsmeister,PhD, and Raymond J. Gibbons, MD

The relation between left ventricular (LV) filling variables measured by gated blood pool radionuelide ventriculography and clinical symptoms and survival was examined in 93 patients who had decreased LV systolic function. The diastolic data were not significantly associated with clinical symptoms. Time to peak filling rate, peak filling rate and ejection fraction were associated independently with survival free of cardiac death (chi-square = 7.74,5.91 and 3.92, respectively, by stepwise Cox regression analysis). A short time to peak filling rate or increased peak filling rate was associated with decreased survival, whereas the opposite indicated a good prognosis. One-year Kaplan-Meier survival was 73 and 98% when time to peak filling rate was below or above the median value of 167 ms, respectively, 62 and 90% when peak filling rate was above or below the median value of 1.67 end-diastolic volumes per second, respectively, and 76 and 95% when LV ejection fraction was below or above the median value of 0.35, respectively. Thus, filling variables (time to peak filling rate and peak filling rate) measured by radionuclide ventriculography may be valuable in predicting survival in patients with decreased LV systolic function. (Am J Cardiol 1661;67:1245-1250)

From the Division of Cardiovascular Diseases and Internal Medicine, the Department of Diagnostic Radiology, and the Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. Manuscript received October 17, 1990, revised manuscript received and accepted February 11,199l. Address for reprints: Ian P. Clements, MD, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.

he determinants of survival in patients with cardiac disease and decreased systolic function are only partially elucidated.’ Diminished left ventricular (LV) ejection fraction has been identified as having prognostic value in determining long-term survival in patients with heart failure with or without coronary artery disease,2,3although some studies have failed to demonstrate a relation between ejection fraction and survival.4,5 Increasing severity of symptoms,5,6 decreased exercise capacity,7 increased plasma norepinephrine levels8 and hyponatremia9 all have been associated with decreased survival in patients with congestive heart failure. Abnormalities of LV diastolic function in the absence of LV systolic dysfunction in patients with hypertrophic and hypertensive cardiomyopathy may explain symptomatic dyspnea.lO,l l The clinical significance of the frequently found LV diastolic filling abnormalities associated with decreased LV systolic function12 is unclear. This study explores the relation between measurements of LV diastolic filling in patients with decreased LV systolic function and their symptoms and survival.


METHODS Patients: In patients undergoing radionuclide ventriculography at rest at the Mayo Clinic, both systolic and diastolic LV function are examined routinely. Patients with an LV ejection fraction

Influence of left ventricular diastolic filling on symptoms and survival in patients with decreased left ventricular systolic function.

The relation between left ventricular (LV) filling variables measured by gated blood pool radionuclide ventriculography and clinical symptoms and surv...
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