Diastolic dysfunction and mortality in 436 360 men and women: the National Echo Database Australia (NEDA). (3rd November 2020)

• Record Type: Journal Article
• Authors: Playford, David; Strange, Geoff; Celermajer, David S; Evans, Geoffrey; Scalia, Gregory M; Stewart, Simon; Prior, David
• Is Part Of: European heart journal. Volume 22:Number 5(2021)
• Page Start: 505
• Page End: 515
• Publication Date: 2020-11-03
• Subjects: echocardiography -- diastolic -- function -- guidelines -- mortality -- big -- data; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa253
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims : To examine the characteristics/prognostic impact of diastolic dysfunction (DD) according to 2016 American Society of Echocardiography (ASE) and European Society of Cardiovascular Imaging (ESCVI) guidelines, and individual parameters of DD. Methods and results : Data were derived from a large multicentre mortality-linked echocardiographic registry comprising 436 360 adults with ≥ 1 diastolic function measurement linked to 100 597 deaths during 2.2 million person-years follow-up. ASE/European Association of Cardiovascular Imaging (EACVI) algorithms could be applied in 392 009 (89.8%) cases; comprising 11.4% of cases with 'reduced' left ventricular ejection fraction (LVEF < 50%) and 88.6% with 'preserved' LVEF (≥50%). Diastolic function was indeterminate in 21.5% and 62.2% of 'preserved' and 'reduced' LVEF cases, respectively. Among preserved LVEF cases, the risk of adjusted 5-year cardiovascular-related mortality was elevated in both DD [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.22–1.42; P < 0.001] and indeterminate status cases (OR 1.11, 95% CI 1.04–1.18; P < 0.001) vs. no DD. Among impaired LVEF cases, the equivalent risk of cardiovascular-related mortality was 1.51 (95% CI 1.15–1.98, P < 0.001) for increased filling pressure vs. 1.25 (95% CI 0.96–1.64, P = 0.06) for indeterminate status. Mitral E velocity, septal e ' velocity, E : e ' ratio, and LAVi all correlated with mortality. On adjusted basis, pivot-points of increased risk for cardiovascular-related mortality occurred at 90 cm/s for E wave velocity, 9 cm/s for septal e ' velocity, an E :e' ratio of 9, and an LAVi of 32 mL/m 2 . Conclusion : ASE/EACVI-classified DD is correlated with increased mortality. However, many cases remain 'indeterminate'. Importantly, when analysed individually, mitral E velocity, septal e ' velocity, E : e ' ratio, and LAVi revealed clear pivot-points of increased risk of cardiovascular-related mortality.