Incremental prognostic value of diastolic dysfunction in low risk patients undergoing echocardiography: beyond Framingham score

Abstract

We sought to assess the prognostic value of diastolic dysfunction (DD) in low-risk adults beyond Framingham risk score (FRS). Consecutive patients without cardiovascular risk factors or co-morbidities were identified from a retrospective cohort. Multivariate binary logistic regression was performed to identify factors associated with DD, and Cox proportional hazard model to evaluate the association of DD with all-cause death. Analysis was repeated by stratifying by the year of the echocardiogram to account for possible time-related shift in measurement techniques. Net reclassification improvement (NRI) was performed to assess incremental prognostic value of DD. The study cohort consisted on 1,039 patients with a mean age (SD) 47.9 (15.7) years. Overall, 346 patients (33.3 %) had DD, among whom 327 were grade 1. Age was the only independent predictor of DD with odds ratio 3.2 (2.8; 3.7) for every 10 years increase (p < 0.0001). After a mean follow-up time (SD) of 7.3 (1.7) years, 71 (6.8 %) patients died. Adjusting for age, gender, and race, DD remained an independent predictor of all-cause mortality with hazard ratio (95 % CI) 2.03 (p = 0.029), and similarly after adjusting for FRS (HR 2.73, p = 0.002) which resulted in IDI gain of 1.4 % (p = 0.0037) and NRI of 15 % (p = 0.029). In 463 age and gender matched subgroups, DD was still an independent predictor of mortality (HR 2.6 [1.25; 5.55], p = 0.01). In low-risk adult outpatients undergoing echocardiography, DD was associated with 2-3 fold increase in risk of death and had incremental prognostic value beyond FRS.

Association Between Sedentary Lifestyle and Diastolic Dysfunction Among Outpatients With Normal Left Ventricular Systolic Function Presenting to a Tertiary Referral Center in the Middle East

“…Aging is known to be the most powerful predictor of diastolic dysfunction, with a 3‐fold increase in odds for every 10 years of aging . Still, the predicted probability of diastolic dysfunction remained significantly higher among physically inactive patients across the full age spectrum of the study population (Figure ).…”

“…Diastolic dysfunction is associated with significant morbidity, hospitalizations for heart failure (HF) symptoms, and all‐cause mortality, even among patients with normal left ventricular (LV) systolic function . There are several well‐known independent predictors of diastolic dysfunction, such as age, obesity, hypertension (HTN), and diabetes mellitus (DM), among others .…”

Association between left ventricular diastolic dysfunction and subclinical coronary artery calcification

“…Diastolic dysfunction is known to be an independent predictor of cardiovascular outcomes in many cohorts and has incremental prognostic value by risk‐stratifying patients with different FRS . Also, worsening of DD over time is an independent predictor of death .…”

How to Identify Hypertensive Patients at High Cardiovascular Risk? The Role of Echocardiography

“…A large body of evidence indicates that assessment of diastolic function by conventional Doppler and tissue Doppler imaging (TDI) provides relevant information about cardiovascular morbidity and mortality independently from traditional risk factors, LV mass and LV geometry [21]. In the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, including 1,839 hypertensive patients without previous cardiovascular events, a ratio of early/atrial mitral flow velocity below the median value conferred an increased risk of cardiovascular events (odds ratio 1.57, 95 % CI 1.11 to 2.18, p \ 0.01) [22].…”