Tomoko Machino-Ohtsuka1, Yoshihiro Seo1, Tomoko Ishizu1, Yoshie Hamada-Harimura1, Masayoshi Yamamoto1, Kimi Sato1, Seika Sai1, Akinori Sugano2, Kenichi Obara3, Ikuo Yoshida4, Isao Nishi5, Kazutaka Aonuma1, Masaki Ieda1. 1. Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan. 2. Department of Cardiology, Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba, Ibaraki, Japan. 3. Department of Cariology, Ryugasaki Saiseikai General Hospital, 1-1, Nakazato, Ryugasaki, Ibaraki, Japan. 4. Department of Cardiology, Moriya Daiichi General Hospital, Moriya, 1-17, Matsumaedai, Moriya, Ibaraki, Japan. 5. Department of Cardiology, Tsuchiura Clinical Education and Training Center, University of Tsukuba Hospital, Tsukuba, Japan.
Abstract
AIMS: Left ventricular diastolic dysfunction (LVDD) has prognostic significance in heart failure (HF). We aimed to assess the impact of LVDD grade stratified by the updated 2016 echocardiographic algorithm (DD2016) on post-discharge outcomes in patients admitted for acute HF and compare with the previous 2009 algorithm (DD2009). METHODS AND RESULTS: The study included 481 patients hospitalized for acute decompensated HF. Comprehensive echocardiography and LVDD evaluation were performed just before hospital discharge. The primary endpoint was a composite of cardiovascular death and readmission for HF. The concordance between DD2016 and DD2009 was moderate (κ = 0.44, P < 0.001); the reclassification rate was 39%. During the follow-up (median: 15 months), 127 (26%) patients experienced the primary endpoint. In the Kaplan-Meier analysis, Grade III in DD2016 showed a lower event-free survival rate than Grades I and II (log rank, P < 0.001 and P = 0.048, respectively) and was independently associated with a higher incidence of the primary endpoint than Grade I [hazard ratio 1.89; 95% confidence interval (CI) 1.17-3.04; P = 0.009]. Grade II or III in DD2016, reflecting elevation of left ventricular (LV) filling pressure, added an incremental predictive value of the primary endpoint to clinical variables irrespective of LV ejection fraction. DD2016 was comparable to DD2009 in predicting the endpoint (net reclassification improvement = 11%; 95% CI -7% to 30%, P = 0.23). CONCLUSION: Despite simplification of the algorithm for LVDD evaluation, the prognostic value of DD2016 for post-discharge cardiovascular events in HF patients was maintained and not compromised in comparison with DD2009. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Left ventricular diastolic dysfunction (LVDD) has prognostic significance in heart failure (HF). We aimed to assess the impact of LVDD grade stratified by the updated 2016 echocardiographic algorithm (DD2016) on post-discharge outcomes in patients admitted for acute HF and compare with the previous 2009 algorithm (DD2009). METHODS AND RESULTS: The study included 481 patients hospitalized for acute decompensated HF. Comprehensive echocardiography and LVDD evaluation were performed just before hospital discharge. The primary endpoint was a composite of cardiovascular death and readmission for HF. The concordance between DD2016 and DD2009 was moderate (κ = 0.44, P < 0.001); the reclassification rate was 39%. During the follow-up (median: 15 months), 127 (26%) patients experienced the primary endpoint. In the Kaplan-Meier analysis, Grade III in DD2016 showed a lower event-free survival rate than Grades I and II (log rank, P < 0.001 and P = 0.048, respectively) and was independently associated with a higher incidence of the primary endpoint than Grade I [hazard ratio 1.89; 95% confidence interval (CI) 1.17-3.04; P = 0.009]. Grade II or III in DD2016, reflecting elevation of left ventricular (LV) filling pressure, added an incremental predictive value of the primary endpoint to clinical variables irrespective of LV ejection fraction. DD2016 was comparable to DD2009 in predicting the endpoint (net reclassification improvement = 11%; 95% CI -7% to 30%, P = 0.23). CONCLUSION: Despite simplification of the algorithm for LVDD evaluation, the prognostic value of DD2016 for post-discharge cardiovascular events in HF patients was maintained and not compromised in comparison with DD2009. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Michael M Hammond; Changyu Shen; Stephanie Li; Dhruv S Kazi; Marwa A Sabe; A Reshad Garan; Lawrence J Markson; Warren J Manning; Allan L Klein; Sherif F Nagueh; Jordan B Strom Journal: PLoS One Date: 2020-12-22 Impact factor: 3.240