Predictors of cardiac events after cardiac resynchronization therapy with tissue Doppler-derived parameters

Background: To evaluate the prognostic value of tissue Doppler imaging (TDI)-derived parameters (E/E' ratio and Tei index) in heart failure (HF) patients who underwent cardiac resynchronization therapy (CRT). Methods and Results: The study comprised 74 consecutive HF patients (mean age 60 +/- 11 years) who underwent CRT. Echocardiography including TDI measurements was performed in all patients at baseline and 3 months after CRT. During a median follow-up period of 720 days (range 210 to 1020 days), 21 patients (28%) had events (8 deaths, and hospitalization for HF in the remaining 13). From the baseline clinical and echocardiography data, univariable Cox-regressions analysis revealed that only diabetes (hazard ratio [HR] 3.703, P <.01), E/A ratio (HR 3.492, P <.001), and E/E' ratio (HR 1.130, P <.001) were predictors for cardiac events. From the 3-month follow-up data, the E/A ratio (HR 2.988, P <.005), E/E' ratio (HR 1.170, P <.001), left ventricular ejection fraction (HR 0.835, P <.01), deceleration time (HR 0.977, P <.05), and the Tei index (HR 15.784, P <.001) were predictors for cardiac events. After multivariable analysis, only diabetes (HR 5.544, P <.05), the 3-month E/E' ratio (HR 1.229, P <.001), and change in Tei index (HR 32.174, P <.001) were independent predictors for cardiac events. Patients with a high baseline and 3-month follow-up E/E' ratio had an 88% cardiac event rate. Conclusions: The Tei index and E/E' ratio are independent predictors of poor response and cardiac events after CRT.