Moderate, severe diastolic dysfunction linked to increased mortality
MedWire News: Moderate and severe diastolic dysfunction (DD) are independent predictors of mortality in patients with normal systolic function, research indicates.
Carmel Halley and colleagues from the Cleveland Clinic in Ohio, USA, found that survival rates are lower in heart failure (HF) patients with moderate or severe DD and normal systolic function than in those with mild DD.
Severe DD is known to be associated with increased mortality in the presence of impaired systolic function but less is known about the effect of DD in patients with preserved systolic function, explain the authors in the Archives of Internal Medicine.
To investigate, Halley et al studied the clinical records and echocardiographic readings of 36,261 consecutive patients (54.4% female) with a mean age of 58.3 years. All patients had normal systolic function (defined as an ejection fraction of 55% or more). The researchers classified diastolic function as normal or abnormal in each patient, then graded DD as mild (impaired relaxation pattern), moderate (pseudonormal pattern), or severe (restrictive filling pattern).
The findings showed that DD was present in 65.2% of patients, with mild DD being the most prevalent form (60.0%).
In all, 5789 deaths occurred during a mean follow-up period of 6.2 years.
The unadjusted survival rate was lower in DD patients than in patients with normal diastolic function, with the risk of mortality increasing with worsening degrees of DD (p<0.001).
After propensity matching adjusted for clinical characteristics including male gender, age, and hypertension, patients with moderate DD were 58% more likely to die, and patients with severe DD 84% more likely to die, than patients with normal diastolic function (p<0.001).
However, mild DD was not an independent predictor of mortality.
"Our results suggest that an increased awareness of the clinical significance of advanced DD may lead to earlier identification of those patients who are at risk, especially at a preclinical stage," report the authors.
In a related commentary, Ileana Piña (Case Western Reserve University, Ohio) hailed Halley and team's research as "novel and important for physicians."
"[They] provide an important piece of the puzzle ie, that DD is common and that physicians need to be aware of the prognostic value of moderate and severe DD," she concluded.
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By Piriya Mahendra