Diastolic function linked to mortality in patients with normal LVEF

2 February 2012

MedWire News: Worse diastolic function is an independent predictor for increased mortality in patients with normal left ventricular ejection fraction (LVEF), say researchers in Circulation.

Wael AlJaroudi (Robert and Arnold Miller Family Heart and Vascular Institute, Cleveland, Ohio) and team investigated whether the progression of diastolic function is associated with increased mortality after finding that there were “limited data” on the subject.

They reviewed the clinical records and echocardiograms of 1065 consecutive patients with an LVEF of 55% or more who underwent an outpatient echocardiogram at the Cleveland Clinic, Ohio, between January 2005 and December 2009. All patients had a repeat echocardiogram at 6–24 months after the first echocardiogram.

At baseline, diastolic dysfunction (DD) was present in 770 (72.3%) patients, with mild DD (defined as grade I DD, impaired relaxation) being the most prevalent (64.9%), and moderate (grade II, pseudonormal) or severe (grade III, restrictive) DD present in only 7.4% of patients.

After a mean follow-up period of 1.6 years from the second echocardiogram, 142 (13%) patients had died.

Unadjusted analysis revealed that patients with worsening diastolic function were at a significantly increased mortality rate compared with those who remained stable or had improved diastolic function, at 21% versus 12% (p=0.001).

Multivariate analysis showed that a decrease in LVEF to less than 55% and a worsening diastolic function were each independently associated with an increased risk for mortality, at hazard ratios of 1.78 for both (p<0.02).

Similarly, worsening of diastolic function from normal to abnormal and from mild to moderate or severe DD were associated with an increase in mortality, at respective hazard ratios of 3.58 and 2.13, respectively (p<0.01).

“This is the largest study to our knowledge to assess the association of progression of diastolic function and mortality in outpatients with normal baseline LVEF,” write the authors.

“Our study showed that DD is not only quite prevalent among outpatients with normal LV [ejection fraction], similarly to recently published data, but is also dynamic.”

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Circulation 2012; Advance online publication