A comparison of echocardiographic measures of diastolic function for predicting all-cause mortality in a predominantly male population
Patricia K Nguyen1, Ingela Schnittger, Paul A Heidenreich
1Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA. patricia.k.nguyen@gmail.com
Insights
Echocardiographic measures of diastolic function, particularly propagation velocity (Vp), predict mortality in diverse patients. Vp independently associated with survival across reduced and preserved ejection fraction groups.
Area of Science:
- Cardiology
- Echocardiography
- Clinical Research
Background:
- Prior studies on echocardiographic diastolic function lacked sample size and diverse populations.
- Established and novel diastolic function measures require independent prognostic value assessment.
Purpose of the Study:
- To determine the independent prognostic value of established and new echocardiographic parameters of diastolic function.
Main Methods:
- 3,604 patients underwent echocardiography over 2 years.
- Measurements included mitral inflow, pulmonary vein pattern, mitral annular motion (e'), and propagation velocity (Vp).
- Primary endpoint was 1-year all-cause mortality.
Main Results:
- Univariate analysis showed most parameters predicted mortality in reduced ejection fraction (EF) and E-wave velocity in preserved EF.
- Multivariate analysis revealed Vp as the sole independent predictor of survival in both reduced and preserved EF groups.
Conclusions:
- Most diastolic function measures predict mortality in a diverse population before adjustment.
- Propagation velocity (Vp) independently associates with total mortality, potentially due to factors beyond diastolic function.
Background:
Prior studies demonstrating the prognostic value of echocardiographic measures of diastolic function have been limited by sample size, have included only select clinical populations, and have not incorporated newer measures of diastolic function nor determined their independent prognostic value. The objective of this study is to determine the independent prognostic value of established and new echocardiographic parameters of diastolic function.
Methods:
We included 3,604 consecutive patients referred to 1 of 3 echocardiography laboratories over a 2-year period. We obtained measurements of mitral inflow velocities, pulmonary vein filling pattern, mitral annulus motion (e'), and propagation velocity (V(p)). The primary end point was 1-year all-cause mortality.
Results:
The mean age of the patients was 68 years, and 95% were male. There were 277 deaths during a mean follow-up of 248 ± 221 days. For patients with reduced left ventricular ejection fraction (LVEF), all measured parameters except for e' were associated with mortality (P < .05) on univariate analysis. For patients with preserved LVEF, the E-wave velocity was significantly associated with mortality (P < .05) on univariate analysis. The deceleration time/E-wave velocity ratio, V(p), and pulmonary vein filling pattern were borderline significant (P < .10). With multivariate analysis, only V(p) was associated with survival for both reduced (P = .02) and preserved LVEF groups (P = .01).
Conclusion:
In a large, clinically diverse population, most measures of diastolic function were predictive of all-cause mortality without adjustment for patient characteristics. On multivariate analysis, only V(p) was independently associated with total mortality. This association with mortality may be related to factors other than diastolic function and warrants further investigation.
