RESULTS:
A total of 154 patients of heart failure with reduced ejection fraction meeting the inclusion criteria were consecutively enrolled in the study. There were 91 male and 63 female patients, with a mean age of 55.71 ± 12.48 years (range, 27-75 years) and there were 119 patients of DCMP (77.27%) and 35 patients were ICMP (22.72%). The baseline demographic and echocardiographic characteristics of the study population are shown in Table 1
Among the study population, 27 patients (17.53%) had hypertension, 23 patients (14.93%) were diabetic, and 13 patients (8.44%) had chronic kidney disease (CKD). Five patients (3.25%) were diagnosed with atrial fibrillation with a controlled ventricular rate, while 149 patients (96.75%) were in normal sinus rhythm. The echocardiographic characteristics of the study participants are summarized in Table 2. During transthoracic echocardiography (TTE) examination, the mean left ventricular ejection fraction (LVEF) was found to be 29.87 ± 5.8, the mean left ventricular global longitudinal strain (GLS) was -8.46 ± 2.74, the mean mitral E/e’ ratio was 13.33 ± 2.74, and the mean left atrial appendage wall velocity was 14.26 ± 5.56. Furthermore, in our study, the mean level of NT pro-BNP, a biomarker for heart failure, was measured to be 980.51 ± 611.77. These findings provide important baseline characteristics and echocardiographic parameters of the study population, allowing for a comprehensive understanding of their cardiovascular health and aiding in the analysis of their cardiac function and status.
We successfully measured LAAWV using transthoracic TDE in a total of 154 patients. The obtained LAAWV values ranged from 2 to 26 cm/s, with a mean LAAW velocity of 14.26±5.56 cm/s. When comparing patients with dilated cardiomyopathy (DCMP) and those with ischemic cardiomyopathy (ICMP), we observed significant differences in mean LAAW velocity. Specifically, patients with DCMP had a mean LAAW velocity of 12.67±5.27 cm/s, while patients with ICMP had a significantly higher mean LAAW velocity of 19.69±1.82 cm/s. Notably, we found a positive correlation between left atrial appendage wall velocities obtained using TDI and left ventricular ejection fraction (LVEF) (r= 0.634, p<0.001). Additionally, we explored the relationship between LAAW velocity and other relevant parameters. We discovered a good inverse correlation between LAAW velocity and left ventricular global longitudinal strain (LV GLS) as well as the serum marker NT pro-BNP (r= -0.671, p<0.001 and r= -0.659, p=0.007, respectively). Furthermore, our study demonstrated a strong inverse correlation between LAAWV values and the mitral E/e’ ratio, which is indicative of diastolic dysfunction (r= -0.756, p<0.001). However, interestingly, we did not find any statistically significant correlation between LAAWV and age (r= 0.121, p=0.135). This suggests that LAAWV may not be influenced significantly by age in the studied patient population. Overall, our study highlights the clinical relevance of measuring LAAW velocity using transthoracic TDE, as it showed significant associations with various important cardiac parameters, including LVEF, LV GLS, NT pro-BNP, and the mitral E/e’ ratio. These findings underscore the potential of LAAWV as a valuable non-invasive tool for assessing cardiac function and understanding the pathophysiology of dilated cardiomyopathy and ischemic cardiomyopathy.