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Diastolic Dysfunction and Survival in Patients With Preserved or Mildly Reduced Left Ventricular Ejection Fraction
Nicole Ivy Chan1, John J Atherton2, Anish Krishnan1
1Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Insights
Diastolic dysfunction (DD) significantly predicts mortality after myocardial infarction (MI) in patients with preserved ejection fraction. This finding reclassifies prognosis in a group where ejection fraction alone is insufficient for risk assessment.
Area of Science:
- Cardiology
- Echocardiography
- Clinical Outcomes
Background:
- Left ventricular ejection fraction (LVEF) is a poor prognostic indicator in myocardial infarction (MI) patients with preserved or mildly reduced LVEF (>40%).
- Guideline-based assessment of diastolic dysfunction (DD) may offer improved prognostic value in this patient subgroup.
Purpose of the Study:
- To evaluate the predictive value of guideline-based diastolic dysfunction (DD) assessment for long-term mortality.
- To determine if DD reclassifies prognosis in MI patients with preserved or mildly reduced LVEF (>40%).
Main Methods:
- Retrospective analysis of 2,234 patients with first-ever MI and LVEF >40%.
- Data collected included clinical, angiographic, and echocardiographic parameters.
- Significant DD defined as grade 2 and 3 DD, assessed early postadmission.
Main Results:
- 14.1% of patients had significant DD.
- At median 4.5-year follow-up, significant DD independently predicted all-cause mortality (HR=2.01) and cardiac mortality (HR=3.97).
- Multivariable analyses and statistical validation confirmed DD's independent association with outcomes.
Conclusions:
- Significant diastolic dysfunction is an independent predictor of mortality post-MI in patients with preserved or mildly reduced LVEF.
- DD effectively reclassifies prognosis in patients where LVEF is otherwise indiscriminate.
- Further research on the clinical implications and treatment strategies for DD in this cohort is warranted.
Background:
Left ventricular ejection fraction (LVEF) is relatively indiscriminate for prognosis in patients with preserved or mildly reduced LVEF (>40%) following myocardial infarction (MI). This study sought to determine the value of guideline-based assessment of diastolic dysfunction (DD) in predicting long-term all-cause and cardiac mortality in patients with a first-ever MI and LVEF >40%.
Methods:
A retrospective single-center study involving 2,234 patients with a first-ever MI (ST elevation MI or non-ST elevation MI) with LVEF >40% was performed. Clinical, angiographic, echocardiographic, and outcomes data were obtained from prospectively maintained institutional and statewide databases. Echocardiography was performed early postadmission for all patients. Significant DD was defined was grade 2 and 3 DD.
Results:
The mean age of patients was 61.4 ± 12.3 years, 70.7% were male, and 12.1% had 3-vessel disease. The mean LVEF was 55.8% ± 7.2%, and 14.1% had significant DD. At a median follow-up of 4.5 years, there were 219 deaths (46 cardiac deaths). On Cox proportional hazards multivariable analyses incorporating significant clinical, angiographic, and echocardiographic variables, significant DD was an independent predictor of both all-cause (hazard ratio = 2.01; 95% CI, 1.37-2.94; P < .001) and cardiac (hazard ratio = 3.97; 95% CI, 1.98-7.99; P < .001) mortality. Bootstrapping and calculation of Harrel's C confirmed the independent association of significant DD with outcomes.
Conclusions:
Significant DD is an independent predictor of all-cause and cardiac mortality following MI in patients with preserved or mildly reduced LVEF and thus effectively reclassifies prognosis in a subgroup where the LVEF is relatively indiscriminate for survival. The benefit of further investigation and/or treatment in this subgroup needs further study.
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