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[Prognostic importance of pseudonormalized left ventricular inflow pattern especially for sudden cardiac death].

The prognostic value of left ventricular inflow velocities by the pulsed Doppler method was studied in 32 patients with congestive heart failure including 18 with old myocardial infarction, 9 with dilated cardiomyopathy, and 5 with hypertensive heart disease, who initially revealed pseudonormalized left ventricular inflow pattern. Pulsed Doppler echocardiography, apexcardiography, and phonocardiography were performed at 3- to 9-month intervals. The prognosis was evaluated for two groups of patients with persistent or transient pseudonormalized inflow patterns. Survival rates at 6 months and 2 years in the total patient population were 78% and 47%, respectively. Twenty-one patients had the pseudonormalized left ventricular inflow pattern (persistent group), while the other 11 patients had a changed pattern (transient group). The survival rate at 2 years was 37% for the persistent group, and 82% for the transient group. Significant differences in patient profiles and the initial data between the two patient groups were the presence of cardiogenic shock (10/21 in persistent group vs 1/11 in transient group; p < 0.001) and the value of left ventricular end-diastolic wall stress (159 +/- 62 g/cm2 in persistent group vs 135 +/- 42 g/cm2 in transient group; p < 0.05). There were no significant differences in NYHA class, the values of left ventricular end-diastolic pressure, left ventricular ejection fraction. A/E ratio, or deceleration half time of left ventricular inflow velocities. Left ventricular end-diastolic wall stress in patients with persistent pseudonormalized left ventricular inflow pattern was significantly increased, and may be related to decreased preload reserve. Atrial fibrillation and atrioventricular dissociation were recorded prior to the development of ventricular fibrillation in two patients with sudden cardiac death. Abrupt loss of atrial contribution as well as ventricular arrhythmias may be a trigger of sudden death. Evaluation and follow-up of the pseudonormalized left ventricular inflow pattern is a sensitive indicator for the management of patients with congestive heart failure.