Left Ventricular Diastolic Function and Long-Term Outcomes in Patients With Normal Exercise Echocardiographic Findings

Abstract

The objective of this study was to determine whether diastolic dysfunction (DD) is associated with outcomes in the absence of myocardial ischemia. We studied 2,835 patients undergoing exercise echocardiography (ExEcho) from January 2006 through December 2006 who had normal systolic function (ejection fraction ≥50%) and absence of exercise-induced wall motion abnormalities. Diastolic function was graded as normal, mild DD, or moderate/severe DD. Medical record review and patient contact was undertaken to determine mortality, cardiovascular events (i.e., death, myocardial infarction (MI), or stroke), incident heart failure (HF) and hospitalization. Mean (SD) age was 58.9 (12.8) years; 54.0% were female. DD was present in 40.0% of participants; 28.2% had mild DD and 11.8% had moderate/severe DD. Over a median follow-up of 4.4 years there were 81 deaths and 114 cardiovascular events, and DD was associated with higher rates of mortality, cardiovascular events, and HF events or hospitalizations (all p<0.001). In multivariate analysis, mild or moderate/severe DD (referent; normal) was associated with HF or hospitalization (HR 1.45 (95% CI 1.18–1.78; p<0.001 for mild DD; HR 1.75 (95% CI 1.37–2.24; p<0.001 for moderate/severe DD) but was not independently associated with death or cardiovascular events. The diastolic index of filling pressure (E/e′) was independently associated with mortality, cardiovascular events, and HF or hospitalizations. In conclusion, among patients without demonstrable myocardial ischemia, left ventricular DD was associated with higher event rates over long-term follow up but did not independently predict hard endpoints other than HF or hospitalization. E/e′ was independently associated with clinical outcomes and may be an important echo-derived parameter to identify in patients undergoing ExEcho.

Association of Increased Epicardial Adipose Tissue Thickness With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation

“… 13 , 34 Left ventricular diastolic dysfunction was correlated to poor CV prognosis. 35 – 37 In our study, the multivariable analysis consistently revealed that increased E/E′ and old age were independently associated with increased EAT thickness. Old age is a well-recognized risk factor of adverse CV events.…”

Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography

“…192 In patients with normal systolic function and absence of exerciseinduced wall motion abnormalities, the ratio of early mitral inflow diastolic velocity to early mitral annulus diastolic velocity (E/eʹ) measured at the time of ESE has been shown to be independently associated with clinical outcomes including mortality, cardiovascular events, and heart failure or hospitalization during long-term followup. 193 Among patients undergoing DSE, those who developed ischemia had lower diastolic annulus velocities at baseline (5.7 6 1.9 vs 6.4 6 1.9 cm/sec, P = .02) and at peak stress (5.2 6 1.6 vs 7.4 6 2.4 cm/s, P < .0001). The increase in E/eʹ was greater in patients who presented with dyspnea, and E/eʹ at peak stress was higher in those with ischemia and persisted into recovery.…”

Patients with left ventricular ejection fraction greater than 58 % have fewer incidences of future acute decompensated heart failure admission and all-cause mortality

“…LV diastolic dysfunction is reportedly an independent predictor of mortality in patients with acute MI [ 23 ] and in patients with HF [ 5 , 24 ]. LV diastolic dysfunction was also recently demonstrated to be an independent predictor of mortality, even in patients with preserved LVEF [ 25 , 26 ]. However, in all of those studies, LV diastolic function was noninvasively evaluated using Doppler echocardiography.…”