الفهرس 
Heart Failure Epidemiology and EtiologyOnly 14 pages are availabe for public view
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Abstract
The Correlation between Left Ventricular Systolic Heart Failure Symptoms Severity and Tissue Doppler Indices
By
Tamer Abdel Rahman El-Khayat
Abstract
Heart failure is a complex clinical syndrome that arises secondary to abnormalities of cardiac structure and/or function (inherited or acquired) that impair the ability of the left ventricle to fill or eject blood. (ACC/AHA 2009 guideline update)
Data on the incidence of heart failure have consistently demonstrates that heart failure is a common problem, and one that increases markedly with advancing age. (Levy, et al; 2002), the prevalence of heart failure is also increasing as the population ages and the proportion of the population over the age of 65 increases. (Butler, et al; 1997)
Ischemic heart disease is currently the most common etiology of chronic heart failure (CHF) in the United States. (Mariell, et al; 2003), Primary valvular disease accounts for 7% of cardiac failure cases, and the majority involves disease of the left-sided cardiac valves. (Ishihara, et al; 1992), Primary disease of the cardiac muscle can present in a number of forms, three basic forms of functional impairment that have been described, Dilated cardiomyopathy (DCM) ,Hypertrophic cardiomyopathy (HCM), Restrictive cardiomyopathy (RCM) (ACC/AHA 2009 guideline update)
There are two types of heart failure patient’s exercise performance: subjective and objective. The subjective methods include NYHA classification, various activity scales, and quality of life specific questionnaires. The objective methods include various modes of exercise testing to document submaximal exercise capacity (6-minute corridor walk test and anaerobic threshold analysis), as well as maximal exercise capacity (exercise time and maximal oxygen consumption measurement). (Mariell, et al; 2003)
A variety of noninvasive imaging modalities are available for assessment of patients with heart failure. These include echocardiography, TDI, radionuclide imaging, and cardiovascular magnetic resonance imaging (CMRI). (Peter, et al; 2007)
The subjects of this study were 50 patients with symptomatic left ventricular systolic dysfunction (EF ≤ 40.0% by echocardiography) attending the heart failure outpatient clinic at the National Heart Institute.
The following patients criteria were excluded, atrial fibrillation, End stage Valvular heart disease, unstable angina pectoris, acute heart failure, recent myocardial infarction within 1 month, and technically inadequate echocardiographic images.
For each patient the following had been done, Functional severity of heart failure according to NYHA classification, Specific activity scale test (Goldman, et al; 1981), Six minutes walking test, Conventional echocardiographic examination, and TDI for the mitral annulus.
Statistical analysis: was done using SPSS version 17 data expressed as mean ± standard deviation correlation between variables was done using the Pearson correlation and spearman’s rho for nonparametric correlations, significance was considered at P value <0.05.
The correlation between variables was done using correlation coefficient (r); examples are NYHA class, specific activity scale function class & six minutes walking distance in the X arm value versus echocardiography parameters as LVEF, LVESD, LVEDD and tissue Doppler indices as average velocity peak systolic velocity (Sm), early (Em) and late (Am) diastolic velocities in the Y arm value.
In our study there was no significant correlation between heart failure symptoms severity as assessed by NYHA function class, specific activity scale, 6 minutes walking test and echo parameters as LVEF, LVEDD, LVESD even though when the study subjects were subdivided into ICM group and DCM group still there was no significant correlation between NYHA classification and echo parameters in both groups.
The results of this study was concordant with (Cohen, et al; 2002) & (smart, et al; 2005) which showed that EF and LV dimensions do not correlate with HF symptoms, exercise capacity, or myocardial oxygen consumption, In spite of that EF and LV dimensions provide crucial prognostic information (Vasan, et al;1999)
In our study the Specific Activity Scale performs satisfactory even when translated from English to Arabic, and there was no studies correlates specific activity scale to echo parameters.
In our study there was no significant correlation between 6 minutes walking test and both echo or TDI parameters and this confirmed by a study by (Alahdab, et al; 2009) on 200 patients found that there was no correlation between 6MWT distance walked and LVEF.
For the first time to our knowledge, our study demonstrate that there was a significant negative correlation between systolic mitral annular velocity (Sm wave) and both NYHA function class and specific activity scale function class, however, there was no significant correlation with six minutes walking test, and when the study subjects were divided into ICM group and DCM group this correlations persist in the DCM group and lost in the ICM group.
In our study there was no significant correlation between systolic heart failure symptoms severity and E’m and there was no previous studies correlating both variables, although E’m has the strongest impact on cardiac mortality among the TDI variables in patients with impaired LV systolic function, (Wang et al; 2005)
In our study there was no correlation between A’m and systolic heart failure symptoms severity and there was no previous studies correlating the two variables.