Correale M, Totaro A, Passero T et al.
Neth Heart J. 2013 May 28

Background

Tissue Doppler imaging (TDI) is an echocardiographic tool to quantitatively assess left ventricle (LV) systolic and diastolic function. Systolic time (St) and ejection time (ET) intervals can be measured in a noninvasive, geometrically independent, easily applicable manner [1,2]. These intervals have, however, not often been evaluated in chronic heart failure (CHF) patients.
Different lines of evidence suggest that statins could be beneficial in patients with CHF, although the mechanisms of potential beneficial effects are not known. Small prospective clinical studies with atorvastatin and simvastatin have reported an improved LV systolic function and decreased inflammatory biomarker levels in systolic HF [3].
Less is known about the effect of statin therapy on LV dysfunction in CHF. This study therefore aimed to investigate whether atorvastatin use may influence prognosis and myocardial performance as evaluated by TDI in CHF patients. 195 patients with CHF and left ventricular ejection fraction (LVEF) <40% either on atorvastatin (n=114) or without statins (n=81) enrolled in the Daunia Heart Failure Registry {4] were analysed with conventional 2D and TDI echocardiography. Clinical follow-up was performed every 6 months for a mean 318 +262 days follow-up.

Main results

• Atorvastatin was associated with a lower incidence of cardiac death (0% vs 7%, P<0.01) than control treatment in patients with CHF and LVEF <40%. This association remained significant after correction for confounders in multivariable analysis (RR: 0.83, 95%CI: 0.71-0.96, P<0.05).

• Patients treated with atorvastatin showed lower early LV filling (E-value: 82.23±32.8 cm/sec vs 97.6±34.5 cm/sec, P=0.01), and lower early to late diastolic LV filling ratio (E/A ratio: 1.7±0.8 vs 2.2±0.8, P<0.001) as measured by conventional echocardiography, lower transmitral to mitral annular (measured by TDI) early diastolic velocity ratio (E/E’ratio: 15±5.7 vs 18±8.3, P<0.01) and higher values of E-deceleration time (EDT: 203.6±95.7 ms vs 173.6±83.2 ms, P<0.05).
• Treatment of atorvastatin was associated with lower incidence of adverse events (death: 10 % vs 26 %, P<0.05; sustained ventricular arrhythmias: 5 % vs 19 %, P<0.05, cardiac death: 0 vs 8 %, P<0.05) and better Doppler findings, as lower values of E/E’ ratio (15.00±5.68 vs 19.72±9.14, P<0.01), E/A ratio (1.85±0.90 vs 2.,48±0.82, p<: 0.01), higher values of St: 353.70±48.96 vs 303.33±68.52 msec, p<0.01) were measured. The association between atorvastatin and lower rates of cardiac death remained statistically significant after correction in a multivariate analysis (RR: 0.77, 95%CI: 0.62-0.95, P<0.05).
• Ischemic CHF patients receiving atorvastatin (n=137) showed longer systolic and diastolic time intervals (IRT (end of S wave to start of E’): 124.06±49.23 vs 86.35±32.87 ms, P<0.01; St (end of A’ wave to end of S wave):354.00±44.82 vs 322.18±62.54 ms, P<0.05; FT (start of E’ to end of A’): 379.37±121.08 vs 317.94±87.61, P<0.05; Dt: 503.43±131.94 vs 404.29±89.82, P<0.01) than controls (n= 44).

Conclusion

Atorvastatin treatment is associated with a lower incidence of cardiac death in CHF patients. Statin administration was related to better LV performance as measured by TDI. The results suggest minor grade of diastolic dysfunction, but lower in patients treated with atorvastatin than in controls. Abnormal parameters in TDI have been associated with increased risk for adverse events in major cardiac disease. Measuring these intervals with TDI can help predict the risk of rehospitalisation in subjects with chronic HF.

References

1. Pai RG, Gill KS. Amplitudes, durations and timings of apically directed left ventricular myocardial velocities: I. Their normal pattern and coupling to ventricular filling and ejection. J Am SocEchocardiogr. 1998;11:105–11.
2. Correale M, Totaro A, Ieva R, et al. Time intervals and myocardial performance index by tissue Doppler imaging. Intern Emerg Med. 2011;6:393–402.
3. Horwich TB, MacLellan WR. Atorvastatin and statins in the treatment of heart failure. Expert Opin Pharmacother. 2007;8:3061–8.
4. Correale M, Brunetti ND, Totaro A, et al. Statin therapy blunts inflammatory activation and improves prognosis and left ventricular performance assessed by Tissue Doppler Imaging in subjects with chronic ischemic heart failure: results from the Daunia Heart Failure Registry. Clinics. 2011;66:777–84.

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