BACKGROUND: Diastolic dysfunction (DD) is highly prevalent and associated with increased morbidity and mortality, but its natural history remains poorly defined. OBJECTIVE: This cohort study sought to characterise the influence of clinical features, medical therapy and echocardiographic parameters on the progression of DD. METHODS: We identified 926 consecutive patients (aged 62 (14) years, 221 women) with DD and preserved systolic function. A repeat echocardiogram was performed in 199 patients > or =1 year after the baseline study (average 3.6 (1.4) years). Follow-up for 4.8 (2.5) years was 97% complete for the major endpoint of all-cause mortality. Cox regression analyses were performed to identify the associations of mortality. RESULTS: Over follow-up, 142 patients died and 22 were admitted with heart failure. The independent predictors of death were age, hyperlipidaemia, co-morbid disease and restrictive filling. The degree of diastolic dysfunction remained stable in 52%, deteriorated in 27% and improved in 21%. There was a greater use of medical therapy in those with stable or worsening diastolic function; when the protective effects of these agents were taken into account in a multivariate model, improvement in diastolic dysfunction was associated with a survival benefit. CONCLUSION: DD is associated with all-cause mortality, independent of the presence of a major co-morbidity. The degree of DD remains stable in about 50% of patients, the population whose diastolic function improves over time has a more favourable outcome.
BACKGROUND:Diastolic dysfunction (DD) is highly prevalent and associated with increased morbidity and mortality, but its natural history remains poorly defined. OBJECTIVE: This cohort study sought to characterise the influence of clinical features, medical therapy and echocardiographic parameters on the progression of DD. METHODS: We identified 926 consecutive patients (aged 62 (14) years, 221 women) with DD and preserved systolic function. A repeat echocardiogram was performed in 199 patients > or =1 year after the baseline study (average 3.6 (1.4) years). Follow-up for 4.8 (2.5) years was 97% complete for the major endpoint of all-cause mortality. Cox regression analyses were performed to identify the associations of mortality. RESULTS: Over follow-up, 142 patients died and 22 were admitted with heart failure. The independent predictors of death were age, hyperlipidaemia, co-morbid disease and restrictive filling. The degree of diastolic dysfunction remained stable in 52%, deteriorated in 27% and improved in 21%. There was a greater use of medical therapy in those with stable or worsening diastolic function; when the protective effects of these agents were taken into account in a multivariate model, improvement in diastolic dysfunction was associated with a survival benefit. CONCLUSION:DD is associated with all-cause mortality, independent of the presence of a major co-morbidity. The degree of DD remains stable in about 50% of patients, the population whose diastolic function improves over time has a more favourable outcome.
Authors: Daniel D Correa de Sa; David O Hodge; Joshua P Slusser; Magaret M Redfield; Robert D Simari; John C Burnett; Horng H Chen Journal: Heart Date: 2010-04 Impact factor: 5.994
Authors: Leanne Groban; Sarah Lindsey; Hao Wang; Marina S Lin; Kimberly A Kassik; Frederico S M Machado; Christy S Carter Journal: Age (Dordr) Date: 2011-07-01
Authors: João L Cavalcante; Josef Marek; Richard Sheppard; Randall C Starling; Paul J Mather; Jeffrey D Alexis; Jagat Narula; Dennis M McNamara; John Gorcsan Journal: Eur Heart J Cardiovasc Imaging Date: 2015-11-30 Impact factor: 6.875
Authors: Chintan S Desai; Laura A Colangelo; Kiang Liu; David R Jacobs; Nakela L Cook; Donald M Lloyd-Jones; Kofo O Ogunyankin Journal: Am J Epidemiol Date: 2012-12-04 Impact factor: 4.897