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Left ventricular diastolic dysfunction worsens prognosis in patients with heart failure due to dilated cardiomyopathy

Mateusz Winiarczyk1,2,3, Ewa Dziewięcka2,3, Sylwia Wiśniowska-Śmiałek2,3,4

  • 1Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland.

ESC Heart Failure
|November 4, 2024
PubMed

Insights

Elevated left atrial pressure (eLAP) and moderate to severe left ventricular diastolic dysfunction (LVDD) are independent predictors of mortality in dilated cardiomyopathy (DCM) patients. Assessing LVDD severity offers prognostic value beyond LV ejection fraction.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Heart Failure Research

Background:

  • Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
  • The prognostic value of left ventricular diastolic dysfunction (LVDD) severity in DCM is not fully understood.
  • Elevated left atrial pressure (eLAP) is a marker of increased cardiac filling pressures.

Purpose of the Study:

  • To investigate the prognostic significance of LVDD severity and eLAP in stable DCM patients.
  • To determine if LVDD severity and eLAP predict mortality independently of other factors.
  • To assess the incremental prognostic value of LVDD severity over LV ejection fraction (LVEF).

Main Methods:

  • Retrospective observational study of 644 DCM patients (2010-2021).
  • LVDD and eLAP assessed via echocardiography per 2016 EACVI guidelines.
  • Primary outcomes: all-cause mortality and heart failure (HF)-related mortality.

Main Results:

  • eLAP was an independent predictor of all-cause mortality (HR 2.0) and HF-related mortality (HR 2.5), even after adjusting for LVEF and atrial fibrillation.
  • Moderate to severe LVDD was associated with significantly higher HF-related mortality rates compared to mild LVDD.
  • 105 (16.3%) patients died during a median follow-up of 41 months.

Conclusions:

  • LVDD severity assessment provides prognostic information in DCM patients beyond LVEF.
  • eLAP is a significant independent predictor of mortality in DCM.
  • These findings underscore the importance of comprehensive diastolic function assessment in DCM management.
Abstract

Keywords:
diastolic dysfunctiondilated cardiomyopathyechocardiography

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