Restrictive transmitral filling pattern in CHF: Relation to hospital readmission
Pts with CHF have frequent hospital readmissions. Restrictive transmitral filling patterns (RFP) are associated with higher LV filling pressures, clinical decompensation and increased mortality. The relationship between RFP and hospital readmission for pts with CHF has not been studied. Methods: Interpretable echo-Doppler studies were reviewed from 37 pts hospitalized for CHF (age 76±9 yrs (mean±SD), males=17). Echocardiographic parameters from pts with (Gp1) and without (Gp2) previous CHF admissions were compared. Chamber size, LVH, LV systolic and valvular function were assessed. RFP was defined as E≥A for pts ≥70 yrs or E = A with blunted systolic pulmonary vein flow for pts <70 yrs. GP I (n=16) GP II (n=21) OR Gp1 v Gp2 95% Cl RFP 14 6 17.5 3.0-100 TR 10 3 10 2.1-48.9 RAE 12 6 9.3 1.9-45.5 SWM 13 8 6.5 1.4-30.3 LAE 16 16 11.0 0.56-200 LVFx 11 8 3.6 0.9-14.2 MR 7 4 3.3 0.8-14.4 LAE, RAE = left atrial, right atrial enlargement; LVFx = significant global LV systolic dysfunction; MR, TR = significant mitral, tricuspid regurgitation; OR=odds ratio; SWM = anteroseptal and/or apical wall motion abnormality. GP I had significantly more RFP, TR, RAE, and SWM than Gp2. RFP was associaled with younger age (73 vs 80 yrs) RAE, LVFx, MR, and TR. There were no differences belween Gp1 and Gp2 in age, sex, length of stay, timing of echo, LVH, LVFx, or valvular function other than TR. Conclusion: RFP, TR, RAE and SWM were associated with CHF hospital readmission, however, RFP was the strongest predictor. Although LVFx and MR correlated with RFP they did not predict hospital readmission. RFP may be a potentially useful parameter to identify CHF pts at risk for recurrent hospitalization.