Echocardiographic diastolic function thresholds indicative of increased mortality risk

Currently recommended echocardiographic diastolic dysfunction thresholds are mostly derived from healthy adult populations rather than outcomes-based metrics. We identified thresholds of diastolic function parameters associated with increased long-term mortality risk.

Retrospective analysis of consecutive patients between 2011 and 2021. Repeat examinations, patients <18 years, critically ill, with left ventricular dysfunction or significant mitral annular calcification or stenosis, or with known or suspected restrictive or dilated cardiomyopathies were excluded. Cox regression models with spline curve analyses determined thresholds associated with increased long-term mortality risk, adjusting for age, gender, hypertension, atrial fibrillation, ischemic heart disease, valvular disease, and left ventricle mass index.

Following exclusions, 57,393 cases were included (mean age 60.1 years, 53.4 % male). Mortality risk increased with mitral annular early diastolic velocity (e') <5.6 cm/s, E / average e' ratio > 12.4, maximal tricuspid regurgitation jet velocity > 2.6 m/s, systolic pulmonary artery pressure > 31.7 mmHg and deceleration time < 184 msec. Left atrial volume index (LAVI <21.2 and > 42 mL/m²), and mitral inflow velocities were associated elevated mortality risk at both high and low thresholds (E wave <0.41 and > 0.88 m/s; E/A < 0.74 and > 1.65).

Revised thresholds for maximal tricuspid regurgitation jet velocity, systolic pulmonary artery pressure and e' were found to be lower, and E/e' and deceleration time thresholds were higher, than cutoffs employed in current recommendations. U-shaped spline curves were observed for LAVI and most mitral inflow velocities, indicating increased mortality risk at low and high thresholds.