Clinical research
Echocardiography and heart failure
Echocardiographic predictors of morbidity and mortality in patients with advanced heart failure: The Beta-blocker Evaluation of Survival Trial (BEST)

https://doi.org/10.1016/j.jacc.2004.12.069Get rights and content
Under an Elsevier user license
open archive

Objectives

The aim of this study was to determine echocardiographic predictors of outcome in patients with advanced heart failure (HF) due to severe left ventricular (LV) systolic dysfunction in the Beta-blocker Evaluation of Survival Trial (BEST).

Background

Previous studies indicate that echocardiographic measurements of LV size and function, mitral deceleration time, and mitral regurgitation (MR) predict adverse outcomes in HF. However, complete quantitative echocardiograms evaluating all of these parameters have not been reported in a prospective randomized clinical trial in the era of modern HF therapy.

Methods

Complete echocardiograms were performed in 336 patients at 26 sites and analyzed by a core laboratory. A Cox proportional-hazards regression model was used to determine which echocardiographic variables predicted the primary end point of death or the secondary end point of death, HF hospitalization, or transplant. Significant variables were then entered into a multivariable model adjusted for clinical and demographic covariates.

Results

On multivariable analysis adjusted for clinical covariates, only LV end-diastolic volume index predicted death (events = 75), with a cut point of 120 ml/m2. Three echocardiographic variables predicted the combined end point of death (events = 75), HF hospitalization (events = 97), and transplant (events = 9): LV end-diastolic volume index, mitral deceleration time, and the vena contracta width of MR. Optimal cut points for these variables were 120 ml/m2, 150 ms, and 0.4 cm, respectively.

Conclusions

Echocardiographic predictors of outcome in advanced HF include LV end-diastolic volume index, mitral deceleration time, and vena contracta width. These variables indicate that LV remodeling, increased LV stiffness, and MR are independent predictors of outcome in patients with advanced HF.

Abbreviations and acronyms

BEST
Beta-blocker Evaluation of Survival Trial
CHF
congestive heart failure
EROA
effective regurgitant orifice area
HF
heart failure
LV
left ventricle/ventricular
LVEF
left ventricular ejection fraction
MR
mitral regurgitation
NYHA
New York Heart Association
SAVE
Survival And Ventricular Enlargement trial
SOLVD
Studies Of Left Ventricular Dysfunction trial
Val-HeFT
Valsartan in Heart Failure Trial

Cited by (0)

This work was supported by the Division of Epidemiology and Clinical Applications of the National Heart, Lung, and Blood Institute and the Department of Veterans Affairs Cooperative Studies Program, through an interagency agreement. Additional support was provided by Dr. Grayburn's K24 award (5 K24 HL03980-06). Dr. Itzhak Kronzon served as Guest Editor for this article.