Diastolic dysfunction and mortality in 436 360 men and women: The National Echo Database Australia (NEDA)
Publication Details
Playford, D.,
Strange, G.,
Celermajer, D. S.,
Evans, G.,
Scalia, G. M.,
Stewart, S.,
Prior, D.,
&
the NEDA Investigators
(2021).
Diastolic dysfunction and mortality in 436 360 men and women: The National Echo Database Australia (NEDA).
European Heart Journal: Cardiovascular Imaging, 22 (5), 505-515.
Abstract
Aims: To examine the characteristics/prognostic impact of diastolic dysfunction (DD) according to 2016 American Society of Echocardiography (ASE) and European Society of Cardiovascular Imaging (ESCVI) guidelines, and individual parameters of DD.
Methods and results: Data were derived from a large multicentre mortality-linked echocardiographic registry comprising 436 360 adults with >_1 diastolic function measurement linked to 100 597 deaths during 2.2 million person-years follow-up. ASE/ European Association of Cardiovascular Imaging (EACVI) algorithms could be applied in 392 009 (89.8%) cases; comprising 11.4% of cases with ‘reduced’ left ventricular ejection fraction (LVEF < 50%) and 88.6% with ‘preserved’ LVEF (>_50%). Diastolic function was indeterminate in 21.5% and 62.2% of ‘preserved’ and ‘reduced’ LVEF cases, respectively. Among preserved LVEF cases, the risk of adjusted 5-year cardiovascular-related mortality was elevated in both DD [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.22–1.42; P < 0.001] and indeterminate status cases (OR 1.11, 95% CI 1.04–1.18; P < 0.001) vs. no DD. Among impaired LVEF cases, the equivalent risk of cardiovascular-related mortality was 1.51 (95% CI 1.15–1.98, P < 0.001) for increased filling pressure vs. 1.25 (95% CI 0.96–1.64, P = 0.06) for indeterminate status. Mitral E velocity, septal e’ velocity, E:e’ ratio, and LAVi all correlated with mortality. On adjusted basis, pivot-points of increased risk for cardiovascular-related mortality occurred at 90 cm/s for E wave velocity, 9 cm/s for septal e’ velocity, an E:e’ ratio of 9, and an LAVi of 32 mL/m2 .
Conclusion: ASE/EACVI-classified DD is correlated with increased mortality. However, many cases remain ‘indeterminate’. Importantly, when analysed individually, mitral E velocity, septal e’ velocity, E:e’ ratio, and LAVi revealed clear pivotpoints of increased risk of cardiovascular-related mortality.
Keywords
echocardiography, diastolic, function, guidelines, mortality, big, da
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