Echocardiographic diastolic function thresholds indicative of increased mortality risk

Area of Science:

• Cardiology
• Echocardiography
• Diastology

Background:

• Current echocardiographic diastolic dysfunction thresholds lack outcomes-based validation.
• Existing metrics are primarily derived from healthy adult populations.

Purpose of the Study:

• To identify diastolic function parameter thresholds associated with increased long-term mortality risk.
• To establish outcomes-based metrics for diastolic dysfunction assessment.

Main Methods:

• Retrospective analysis of 57,393 patient cases from 2011-2021.
• Exclusion of patients with specific cardiac conditions or limitations.
• Cox regression models with spline curve analyses to determine mortality-associated thresholds.

Main Results:

• Increased mortality risk observed with mitral annular early diastolic velocity (e') <5.6 cm/s and E/average e' ratio >12.4.
• Higher maximal tricuspid regurgitation jet velocity (>2.6 m/s) and systolic pulmonary artery pressure (>31.7 mmHg) indicated elevated risk.
• U-shaped mortality risk curves for Left Atrial Volume Index (LAVI) and mitral inflow velocities at both low and high thresholds.

Conclusions:

• Revised thresholds for several diastolic parameters (e', systolic pulmonary artery pressure, tricuspid regurgitation jet velocity) are proposed.
• Current recommendations may need updating based on these outcomes-derived thresholds.
• Diastolic dysfunction assessment using these new thresholds can improve long-term mortality risk prediction.