Marzia Rigolli1, Andrea Rossi2, Miguel Quintana3, Allan L Klein4, Cheuk-Man Yu5, Stefano Ghio6, Frank L Dini7, David Prior8, Richard W Troughton9, Pier L Temporelli10, Katrina K Poppe11, Robert N Doughty11, Gillian A Whalley12. 1. Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; University of Verona, Verona, Italy. 2. University of Verona, Verona, Italy. 3. Karolinska Institute, Sweden. 4. Cleveland Clinic Foundation, OH, USA. 5. Chinese University of Hong Kong, Hong Kong, China. 6. Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 7. Santa Chiara Hospital, University of Pisa, Pisa, Italy. 8. St Vincents Hospital, Melbourne, Australia. 9. Christchurch School of Medicine, University of Otago, Christchurch, New Zealand. 10. Fondazione Salvatore Maugeri, IRCCS, Veruno (Italy). 11. Department of Medicine, University Of Auckland, Auckland, New Zealand. 12. Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; Unitec Institute of Technology, Auckland, New Zealand. Electronic address: gwhalley@unitec.ac.nz.
Abstract
OBJECTIVE: To determine the prognostic implications of diastolic filling grades and identify whether age-stratified E/A ratio alone can identify patients at high risk of death post-AMI and HF. We hypothesized that in response to ageing and pathology, a normal E/A (>1) could be considered abnormal in patients post-AMI older than 65years, and that in patients with symptomatic HF, a normal E/A always represents advanced diastolic dysfunction. METHODS AND RESULTS: This is a sub-analysis of the Meta-analysis Research Group in Echocardiography (MeRGE) which combined individual patient data from 30 prospective studies and demonstrated that restrictive filling was an important and independent predictor of all-cause mortality. This sub-analysis is restricted to those studies in which continuous E/A data were available (20 studies) and includes a total of 3082 AMI and 2321 HF patients. Patients were classified at the time of echocardiography into four filling patterns: normal, abnormal relaxation, pseudonormal, and restrictive filling. Post-AMI patients were divided into four groups on the basis of age and E/A, while patients with HF were classified into three groups, based on only E/A. Mortality across groups was compared using Kaplan-Meier survival analysis and Cox proportional hazards. In multivariable analyses in the AMI patients, age-stratified E/A was an independent predictor of outcome (HR 1.43 (95% CI: 1.31-1.56)), and in the HF cohort, E/A was confirmed as an independent predictor of mortality (HR 1.12 (95% CI 1.09-1.16)) alongside age and ejection fraction. CONCLUSIONS: Age-stratified E/A is an independent predictor of mortality after AMI and in HF patients, regardless of left ventricular ejection fraction, age and gender. E/A ratio could be a first step echocardiographic risk stratification, which could precede and indicate the need for more advanced diagnostic and prognostic considerations in high-risk AMI and HF patients.
OBJECTIVE: To determine the prognostic implications of diastolic filling grades and identify whether age-stratified E/A ratio alone can identify patients at high risk of death post-AMI and HF. We hypothesized that in response to ageing and pathology, a normal E/A (>1) could be considered abnormal in patients post-AMI older than 65years, and that in patients with symptomatic HF, a normal E/A always represents advanced diastolic dysfunction. METHODS AND RESULTS: This is a sub-analysis of the Meta-analysis Research Group in Echocardiography (MeRGE) which combined individual patient data from 30 prospective studies and demonstrated that restrictive filling was an important and independent predictor of all-cause mortality. This sub-analysis is restricted to those studies in which continuous E/A data were available (20 studies) and includes a total of 3082 AMI and 2321 HF patients. Patients were classified at the time of echocardiography into four filling patterns: normal, abnormal relaxation, pseudonormal, and restrictive filling. Post-AMI patients were divided into four groups on the basis of age and E/A, while patients with HF were classified into three groups, based on only E/A. Mortality across groups was compared using Kaplan-Meier survival analysis and Cox proportional hazards. In multivariable analyses in the AMI patients, age-stratified E/A was an independent predictor of outcome (HR 1.43 (95% CI: 1.31-1.56)), and in the HF cohort, E/A was confirmed as an independent predictor of mortality (HR 1.12 (95% CI 1.09-1.16)) alongside age and ejection fraction. CONCLUSIONS: Age-stratified E/A is an independent predictor of mortality after AMI and in HF patients, regardless of left ventricular ejection fraction, age and gender. E/A ratio could be a first step echocardiographic risk stratification, which could precede and indicate the need for more advanced diagnostic and prognostic considerations in high-risk AMI and HF patients.
Authors: Agnieszka Kapłon-Cieślicka; Cécile Laroche; Maria G Crespo-Leiro; Andrew J S Coats; Stefan D Anker; Gerasimos Filippatos; Aldo P Maggioni; Camilla Hage; Antonio Lara-Padrón; Alessandro Fucili; Jarosław Drożdż; Petar Seferovic; Giuseppe M C Rosano; Alexandre Mebazaa; Theresa McDonagh; Mitja Lainscak; Frank Ruschitzka; Lars H Lund Journal: ESC Heart Fail Date: 2020-07-02