One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fraction

Background: Wave intensity (WI) is a hemodynamic index used to evaluate the interaction between the heart and the arterial system, measured with an echo-Dopplersystem at the level of the common carotid artery. WI has two peaks: W1 during early systole that represents left ventricular (LV) contractility, and W2 in late systole that is related to the inertia force during isovolumetric relaxation. The aim of this study was to determine whether WI parameters improve the prediction of poor outcome in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Sixty-two patients (mean age 69.4+11.5 years) in NYHA class II-III were followed up for 43.5 months. They underwent routine clinical work-up, transthoracic echocardiography and WI measurement. A stratified survival analysis was conducted using the Kaplan-Meier method. Results: During follow-up, 23 patients died from cardiovascular causes. Survivors and non-survivirs were similar in age, blood pressure, heart rate and echocardiographic parameters, except for LVend-diastolic volume indexed to body surface area, E/A ratio (higher in non-survivors) and deceleration time (lower in non-survivors). W2 (1950+1006 vs 1117+708 mmHg m/s3, p=0.001) was significantly lower in non-survivors, whereas W1 (6951+4119 vs 5748+3891 mmHg m/s3, p=NS) was similar. At the end of followup, cardiovascular mortality was higher in patients with W1 ≤3900 mmHg m/s3 (p=0.02) and W2 ≤1000 mmHg m/s3 (p=0.0002). Only E/A (cut-off 1.5) was predictive of mortality (p=0.05). Conclusions: In patients with HFrEF, WI parameters derived from the carotid artery better identified patients with poor prognosis and were significant predictors of cardiovascular mortality.