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Diastolic dysfunction predicted mortality in patients with normal systolic function
Halley CM. Arch Intern Med. 2011;171:1082-1087.
Piña IL. Arch Intern Med. 2011;171:1088-1089.
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Diastolic dysfunction in the presence of impaired systolic dysfunction is associated with mortality, but a new study has found that diastolic dysfunction in patients with normal systolic function is also predictive of mortality.
In the study, researchers from the Cleveland Clinic found that both moderate and severe diastolic dysfunction as assessed by echocardiography among patients with normal systolic function was linked with mortality. However, mild diastolic dysfunction was not.
“This finding has important clinical implications, especially given the high prevalence of mild diastolic dysfunction in the population studied,” they wrote.
The study population included 36,261 patients (mean age, 58.3 years; 54.4% female) with normal ejection fraction (>55%) between January 1996 and December 2005. Researchers determined diastolic function on the basis of four echocardiographic Doppler variables: normal (n=12,603), mild dysfunction (grade 1; n=21,758), moderate dysfunction (grade 2; n=1,773) and severe dysfunction (grade 3; n=127).
Overall, patients who were male, obese (BMI >30) and older than 65 years were more likely to have diastolic dysfunction.
During a mean follow-up of 6.2 years, 5,789 deaths were reported. According to unadjusted analysis, survival was worse depending on the presence and degree of diastolic dysfunction (P<.001). The researchers then performed propensity matching and found that moderate (HR=1.58) and severe (HR=1.84; P<.001) diastolic dysfunction were significantly associated with an increased risk for mortality.
For Ileana L. Piña, MD, with Case Western Reserve University, Cleveland, and author of the accompanying editorial, these findings lend credence to the complexity of HF with preserved ejection fraction beyond only diastolic dysfunction and of the ways patients ultimately progress to frank HF.
“Halley et al provide an important piece of the puzzle (ie, that diastolic dysfunction is common and that physicians need to be aware of the prognostic value of moderate and severe diastolic dysfunction),” she wrote. “The missing link between diastolic dysfunction diagnosed via echocardiographic testing and the acute presentation of older women with HF with preserved ejection fraction is yet to be elucidated. Further work will help solve this puzzle.”
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