Mortality Rate in Patients With Diastolic Dysfunction and Normal Systolic Function

Study Questions:

What is the clinical relevance of the presence of diastolic dysfunction (DD) and the degree of DD in patients with normal ejection fraction?


The investigators reviewed clinical records and echocardiographic findings of consecutive patients who underwent an outpatient echocardiogram that revealed normal systolic function (ejection fraction >55%) from January 1, 1996, through December 31, 2005. Diastolic function was graded using echocardiographic Doppler variables designated as normal, mild (grade I, i.e., impaired relaxation pattern), moderate (grade II, i.e., pseudonormal pattern), or severe (grade III, i.e., restrictive filling pattern) dysfunction. Propensity analysis was performed to compare outcomes among the groups.


A total of 36,261 patients were identified (mean [standard deviation] age, 58.3 [15.4] years; 54.4% female) with a mean follow-up time of 6.2 (2.3) years. In 65.2% of the cohort, DD was present, with mild DD being the most prevalent type of dysfunction. A total of 5,789 deaths occurred during the follow-up period. The unadjusted survival rate was worse according to the presence and degree of DD (p < 0.001). However, after propensity matching, only moderate and severe DD were associated with an increased mortality risk (hazard ratio, 1.58; 95% confidence interval, 1.20-2.08 and hazard ratio, 1.84; 1.29-2.62, respectively; p < 0.001 for each).


The authors concluded that the presence of moderate or severe DD was an independent predictor of mortality.


The study suggests that in a single-center cohort of patients with normal ejection fraction referred for outpatient echocardiographic testing for a variety of indications, DD, especially mild DD, was highly prevalent. After adjustment for a number of cardiac and noncardiac comorbidities, moderate and severe DD were independent predictors of mortality during follow-up, but mild DD was not. Further studies are needed to identify the potential mechanisms by which moderate and severe DD independently confer mortality risk to assess whether a targeted therapeutic approach directed at DD can improve survival.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Echocardiography, Doppler, Follow-Up Studies, Survival Rate, Heart Failure, Diastole, Systole, Echocardiography

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