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Adverse Cardiac Events and the Impaired Relaxation Left Ventricular Filling Pattern

Steven J Lavine1, Kais Al Balbissi2

  • 1University of Florida-Jacksonville, Jacksonville, Florida; Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|March 24, 2016
PubMed

Insights

Patients with grade 1 diastolic dysfunction and preserved ejection fraction face increased heart failure risk if they have left ventricular hypertrophy or elevated filling pressures. These factors also increase mortality risk.

Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Diastolic dysfunction (DD) grade correlates with heart failure (HF) incidence.
  • Grade 1 DD with preserved ejection fraction may present with left atrial dilatation, specific E/e' ratios, and increased left ventricular (LV) mass.
  • The study investigated if LV hypertrophy or an E/e' ratio > 8 predicts higher HF incidence in these patients.

Purpose of the Study:

  • To determine if left ventricular hypertrophy or elevated LV filling pressures (E/e' ratio > 8) are associated with increased heart failure incidence in patients with grade 1 diastolic dysfunction and preserved ejection fraction.
  • To identify predictors of heart failure and mortality in this specific patient cohort.

Main Methods:

  • Retrospective study of 212 patients with grade 1 DD and ejection fraction > 50%.
  • Patients were divided into two groups: Group 1 (E/A < 0.8, no LV hypertrophy, e' < 8 cm/sec, E/e' < 8) and Group 2 (LV hypertrophy or E/e' > 8).
  • Echocardiographic parameters (LV/left atrial volumes, transmitral flow, tissue Doppler) and clinical data (HF admissions, mortality) were analyzed.

Main Results:

  • Group 2 exhibited significantly greater LV and left atrial volumes, LV mass index, and E/e' ratios compared to Group 1 (P < .01).
  • Heart failure incidence was substantially higher in Group 2 (30% vs 4%, P < .001).
  • Combined heart failure or all-cause mortality was also significantly greater in Group 2 (46% vs 14%, P < .001).

Conclusions:

  • Increased heart failure incidence and mortality were observed in patients with grade 1 DD when accompanied by LV hypertrophy or elevated LV filling pressures.
  • Multivariate analysis confirmed E/e' ratio, systolic blood pressure, and LV mass index as significant predictors of HF.
  • E/e' ratio, LV mass index, and lower calcium channel blocker use were associated with combined HF or all-cause mortality.
Abstract

Keywords:
Diastolic dysfunctionHeart failureLeft ventricular filling pressuresLeft ventricular mass

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