1. 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 (2002-2007) 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

2. Echocardiographic Tissue Doppler Imaging Is a Powerful Independent Prognosticator of Overall Mortality in the General Population Results From the Fourth Copenhagen City Heart Study (2002-2007) Rasmus Mogelvang The Copenhagen City Heart Study & Department of Cardiology, Gentofte University Hospital Denmark Survival Time Normal Abnormal

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

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

5. Methods 1,100 persons from the Copenhagen City Heart Study Conventional Echocardiography & Tissue Doppler Imaging Mean Follow-up: 5.1 years http://www.lib.utexas.edu/maps Copenhagen 5

6. Survivors Non-survivors (n=946) (n=90) Age - years 58 74 P<0.001 Hypertension – % 42 72 P<0.001 Body Mass Index – kg/m 2 25.6 25.7 P=0.91 Heart rate – beats per minute 69 71 P=0.10 Male gender – % 41 44 P=0.58 Diabetes - % 7 13 P<0.04 Ischemic heart disease - % 8 21 P<0.001 Severe diastolic dysfunction – % 0.7 1.2 P=0.47 Left ventricular ejection fraction <50% - % 0.9 3.5 P<0.05 Left ventricular dilatation - % 5.7 5.5 P=1.00 Left ventricular hypertrophy - % 15 37 P<0.001 P-value Characteristics of the Study Population 6

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

8. Tissue Doppler Imaging Systole s’ Diastole e’ a’ s’ e’ a’ Survivors Non-survivors s’ – cm/s 6.1 5.3 a’ – cm/s 6.7 6.3 e’ – cm/s 7.2 5.4 8

9. Kaplan-Meier Survival Plots Survival - % 100 95 90 85 1 2 3 4 5 Follow-up in years 6 High values Medium values Low values s’ Survival - % 100 95 90 85 1 2 3 45 6 Medium values Low values High values a’ 9

10. Kaplan-Meier Survival Plots Survival - % 100 95 90 85 Survival - % 100 95 90 85 1 2 3 4 5 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<0.001 10

11. Kaplan-Meier Survival Plot for e’ Survival - % 100 95 90 85 1 2 3 4 5 Follow-up in years 6 High Medium Low e’ values 80 Multivariate analysis Relative Risk 1.02 (0.90-1.16); P=0.77 11

12. 10 cm/s a’ e’ s’ 8 6 4 2 s’, e’, and a’ according to increasing age 12

13. 10 cm/s 8 6 4 2 a’ e’ s’ s’, e’, and a’ according to increasing age 13

14. r=-0.4 r=-0.8 r=0.3 10 cm/s 8 6 4 2 a’ e’ s’ s’, e’, and a’ according to increasing age 14

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

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

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

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

19. Kaplan-Meier Survival Plot for the eas-index 1 2 3 4 5 Follow-up in years 6 1. tertile Survival - % 100 95 90 85 2. tertile 3. tertile Adjusted for age and sex Multivariate analysis 3.tertile vs. 1.tertile Relative Risk 2.6 (1.4-4.7); P<0.003 19

20. 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