Presenter Disclosure Information Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General Population Results From the Fourth Copenhagen City Heart Study ( ) Disclosure information The following relationships exist related to this presentation: Rasmus Mogelvang – No disclosures Peter Sogaard – Consulting fees GE Healthcare Modest level Sune A. Pedersen – No disclosures Niels T. Olsen – No disclosures Peter Schnohr – No disclosures Jan S. Jensen – No disclosures

Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General Population Results From the Fourth Copenhagen City Heart Study ( ) Rasmus Mogelvang The Copenhagen City Heart Study & Department of Cardiology, Gentofte University Hospital Denmark Survival Time Normal Abnormal

The Failing Heart Heart Failure High morbidity and mortality Increasing incidence 3

High morbidity and mortality Increasing incidence Constant advances in treatment Early identification Echocardiography Tissue Doppler Imaging The Failing Heart Heart Failure versus 4 Conventional

Methods 1,100 persons from the Copenhagen City Heart Study Conventional Echocardiography & Tissue Doppler Imaging Mean Follow-up: 5.1 years Copenhagen 5

Survivors Non-survivors (n=946) (n=90) Age - years P<0.001 Hypertension – % P<0.001 Body Mass Index – kg/m P=0.91 Heart rate – beats per minute P=0.10 Male gender – % P=0.58 Diabetes - % 7 13 P<0.04 Ischemic heart disease - % 8 21 P<0.001 Severe diastolic dysfunction – % P=0.47 Left ventricular ejection fraction <50% - % P<0.05 Left ventricular dilatation - % P=1.00 Left ventricular hypertrophy - % P<0.001 P-value Characteristics of the Study Population 6

Tissue Doppler Imaging Systole Diastole s’ e’ a’ 7

Tissue Doppler Imaging Systole s’ Diastole e’ a’ s’ e’ a’ Survivors Non-survivors s’ – cm/s a’ – cm/s e’ – cm/s

Kaplan-Meier Survival Plots Survival - % Follow-up in years 6 High values Medium values Low values s’ Survival - % Medium values Low values High values a’ 9

Kaplan-Meier Survival Plots Survival - % Survival - % Follow-up in years 6 High values Medium values Low values High values s’ a’ 8 cm/s vs. 3 cm/s RR 3.0 Multivariate Analysis RR 1.25 per cm/s; P<0.04 RR 1.25 per cm/s; P<

Kaplan-Meier Survival Plot for e’ Survival - % Follow-up in years 6 High Medium Low e’ values 80 Multivariate analysis Relative Risk 1.02 ( ); P=

10 cm/s a’ e’ s’ s’, e’, and a’ according to increasing age 12

10 cm/s a’ e’ s’ s’, e’, and a’ according to increasing age 13

r=-0.4 r=-0.8 r= cm/s a’ e’ s’ s’, e’, and a’ according to increasing age 14

e’/a’ Systole Diastole s’ e’ a’ 15 e’/a’

Systole Diastole s’ e’ a’ 16 e’/a’ Interdependence of s’, e’, and a’

Systole Diastole s’ e’ a’ e’/s’ 17 e’/a’

Interdependence of s’, e’, and a’ s’ e’ a’ e’/s’ e’/a’ (e’/a’)/s’ 18 eas-index

Kaplan-Meier Survival Plot for the eas-index Follow-up in years 6 1. tertile Survival - % tertile 3. tertile Adjusted for age and sex Multivariate analysis 3.tertile vs. 1.tertile Relative Risk 2.6 ( ); P<

Tissue Doppler imaging is a powerful prognosticator - even in the presence of a normal conventional echocardiographic examination 1 Conclusions Tissue Doppler imaging is a powerful prognosticator, even in the presence of a normal conventional echocardiographic examination 1 Low values of s’ and a’ were significant predictors of death in the general population 2 2 Low values of s’ and a’ were significant predictors of death Combining the information of systolic and diastolic performance strengthens the prognostic value of tissue Doppler imaging 3 Combining the information of systolic and diastolic performance strengthens the prognostic value of tissue Doppler imaging Survival Time TDI Normal TDI Abnormal 3