The International Journal of Cardiovascular Imaging

, Volume 31, Issue 7, pp 1369–1378 | Cite as

One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fraction

  • Olga Vriz
  • Marco Pellegrinet
  • Concetta Zito
  • Vitantonio di Bello
  • Manola Bettio
  • Scipione Carerj
  • Antonello Cittadini
  • Eduardo Bossone
  • Francesco Antonini-Canterin
Original Paper


Wave intensity (WI) is a hemodynamic index used to evaluate the interaction between the heart and the arterial system, measured with an echo-Doppler system at the level of the common carotid artery. WI has two peaks: W1 during early systole that represents left ventricular (LV) contractility, and W2 in late systole that is related to the inertia force during isovolumetric relaxation. The aim of this study was to determine whether WI parameters improve the prediction of poor outcome in patients with heart failure and reduced ejection fraction (HFrEF). Sixty-two patients (mean age 69.4 ± 11.5 years) in NYHA class II–III were followed up for 43.5 months. They underwent routine clinical work-up, transthoracic echocardiography and WI measurement. A stratified survival analysis was conducted using the Kaplan–Meier method. During follow-up, 23 patients died from cardiovascular causes. Survivors and non-survivors were similar in age, blood pressure, heart rate and echocardiographic parameters, except for LV end-diastolic volume indexed to body surface area, E/A ratio (higher in non-survivors) and deceleration time (lower in non-survivors). W2 (1950 ± 1006 vs 1117 ± 708 mmHg m/s3, p = 0.001) was significantly lower in non-survivors, whereas W1 (6951 ± 4119 vs 5748 ± 3891 mmHg m/s3, p = NS) was similar. At the end of follow-up, cardiovascular mortality was higher in patients with W1 ≤ 3900 mmHg m/s3 (p = 0.02) and W2 ≤ 1000 mmHg m/s3 (p = 0.0002). Only E/A (cut-off 1.5) was predictive of mortality (p = 0.05). In patients with HFrEF, WI parameters derived from the carotid artery better identified patients with poor prognosis and were significant predictors of cardiovascular mortality.


Cardiovascular mortality Ejection fraction Heart failure Wave intensity 



The authors are indebted to Dr. Stevo Julius for critical review and final approval of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Olga Vriz
    • 1
  • Marco Pellegrinet
    • 2
  • Concetta Zito
    • 3
  • Vitantonio di Bello
    • 4
  • Manola Bettio
    • 1
  • Scipione Carerj
    • 3
  • Antonello Cittadini
    • 5
  • Eduardo Bossone
    • 6
  • Francesco Antonini-Canterin
    • 2
  1. 1.Cardiology and Emergency DepartmentSant’Antonio HospitalSan Daniele del FriuliItaly
  2. 2.Cardiology, ARCS. Maria degli Angeli HospitalPordenoneItaly
  3. 3.Institute of CardiologyUniversity of MessinaMessinaItaly
  4. 4.Cardiac Thoracic and Vascular DepartmentUniversity of PisaPisaItaly
  5. 5.Department of Translational Medical SciencesFederico II UniversityNaplesItaly
  6. 6.Department of Cardiac SurgeryIRCCS Policlinico San DonatoSan Donato MilaneseItaly

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