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Incremental prognostic value of diastolic dysfunction in low risk patients undergoing echocardiography: beyond Framingham score

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Abstract

We sought to assess the prognostic value of diastolic dysfunction (DD) in low-risk adults beyond Framingham risk score (FRS). Consecutive patients without cardiovascular risk factors or co-morbidities were identified from a retrospective cohort. Multivariate binary logistic regression was performed to identify factors associated with DD, and Cox proportional hazard model to evaluate the association of DD with all-cause death. Analysis was repeated by stratifying by the year of the echocardiogram to account for possible time-related shift in measurement techniques. Net reclassification improvement (NRI) was performed to assess incremental prognostic value of DD. The study cohort consisted on 1,039 patients with a mean age (SD) 47.9 (15.7) years. Overall, 346 patients (33.3 %) had DD, among whom 327 were grade 1. Age was the only independent predictor of DD with odds ratio 3.2 (2.8; 3.7) for every 10 years increase (p < 0.0001). After a mean follow-up time (SD) of 7.3 (1.7) years, 71 (6.8 %) patients died. Adjusting for age, gender, and race, DD remained an independent predictor of all-cause mortality with hazard ratio (95 % CI) 2.03 (p = 0.029), and similarly after adjusting for FRS (HR 2.73, p = 0.002) which resulted in IDI gain of 1.4 % (p = 0.0037) and NRI of 15 % (p = 0.029). In 463 age and gender matched subgroups, DD was still an independent predictor of mortality (HR 2.6 [1.25; 5.55], p = 0.01). In low-risk adult outpatients undergoing echocardiography, DD was associated with 2–3 fold increase in risk of death and had incremental prognostic value beyond FRS.

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References

  1. Senni M, Tribouilloy CM, Rodeheffer RJ et al (1998) Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation 98:2282–2289

    Article  PubMed  CAS  Google Scholar 

  2. Angeja BG, Grossman W (2003) Evaluation and management of diastolic heart failure. Circulation 107:659–663

    Article  PubMed  Google Scholar 

  3. Wang M, Yip GW, Wang AY et al (2005) Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy. J Hypertens 23:183–191

    Article  PubMed  Google Scholar 

  4. Halley CM, Houghtaling PL, Khalil MK et al (2011) Mortality rate in patients with diastolic dysfunction and normal systolic function. Arch Intern Med 171:1082–1087

    Article  PubMed  Google Scholar 

  5. Redfield MM, Jacobsen SJ, Burnett JC Jr et al (2003) Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289:194–202

    Article  PubMed  Google Scholar 

  6. Mogelvang R, Sogaard P, Pedersen SA et al (2009) Cardiac dysfunction assessed by echocardiographic tissue Doppler imaging is an independent predictor of mortality in the general population. Circulation 119:2679–2685

    Article  PubMed  Google Scholar 

  7. Jaber WA, Menon V, Houghtaling PL et al (2011) Increased BMI is associated with worsening diastolic function in patients with normal systolic function. Circulation 124:A15105

    Google Scholar 

  8. Kane G, Karon B, Mahoney D et al (2011) Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA 306:856–863

    Article  PubMed  CAS  Google Scholar 

  9. Russo C, Jin Z, Homma S et al (2011) Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort. J Am Coll Cardiol 57:1368–1374

    Article  PubMed  Google Scholar 

  10. AlJaroudi W, Alraies M, Halley C et al (2012) Impact of progression of diastolic dysfunction on mortality in patients with normal ejection fraction. Circulation 125:782–788

    Article  PubMed  Google Scholar 

  11. Quinones MA, Otto CM, Stoddard M et al (2002) Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15:167–184

    Article  PubMed  Google Scholar 

  12. Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. J Am Coll Cardiol 30:8–18

    Article  PubMed  CAS  Google Scholar 

  13. Nagueh SF, Appleton CP, Gillebert TC et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133

    Article  PubMed  Google Scholar 

  14. Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  15. Devereux RB, Alonso DR, Lutas EM et al (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458

    Article  PubMed  CAS  Google Scholar 

  16. de Simone G, Daniels SR, Devereux RB et al (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260

    Article  PubMed  Google Scholar 

  17. Levey AS, Coresh J, Greene T et al (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254

    Article  PubMed  CAS  Google Scholar 

  18. (1998) Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med 158:1855–1867

  19. Lauer MS, Blackstone EH, Young JB et al (1999) Cause of death in clinical research: time for a reassessment? J Am Coll Cardiol 34:618–620

    Article  PubMed  CAS  Google Scholar 

  20. D’Agostino RB, Russell MW, Huse DM et al (2000) Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J 139:272–281

    Article  PubMed  Google Scholar 

  21. Pencina MJ, D’Agostino RB Sr, Steyerberg EW (2011) Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med 30:11–21

    Article  PubMed  Google Scholar 

  22. Arbab-Zadeh A, Dijk E, Prasad A et al (2004) Effect of aging and physical activity on left ventricular compliance. Circulation 110:1799–1805

    Article  PubMed  Google Scholar 

  23. Prasad A, Popovic ZB, Arbab-Zadeh A et al (2007) The effects of aging and physical activity on Doppler measures of diastolic function. Am J Cardiol 99:1629–1636

    Article  PubMed  Google Scholar 

  24. Lam CS, Lyass A, Kraigher-Krainer E et al (2011) Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community. Circulation 124:24–30

    Article  PubMed  CAS  Google Scholar 

  25. Douglas PS, Garcia MJ, Haines DE et al (2011) ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol 57:1126–1166

    Article  PubMed  Google Scholar 

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The study was approved by the Institutional Review Board.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA

    Wael A. AlJaroudi, M. Chadi Alraies, Carmel Halley, Venu Menon, L. Leonardo Rodriguez, Richard A. Grimm, James D. Thomas & Wael A. Jaber

  2. Division Cardiovascular Medicine, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107, Lebanon

    Wael A. AlJaroudi

Authors
  1. Wael A. AlJaroudi
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  2. M. Chadi Alraies
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  3. Carmel Halley
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  4. Venu Menon
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  5. L. Leonardo Rodriguez
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  6. Richard A. Grimm
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  7. James D. Thomas
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  8. Wael A. Jaber
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Correspondence to Wael A. AlJaroudi.

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AlJaroudi, W.A., Alraies, M.C., Halley, C. et al. Incremental prognostic value of diastolic dysfunction in low risk patients undergoing echocardiography: beyond Framingham score. Int J Cardiovasc Imaging 29, 1441–1450 (2013). https://doi.org/10.1007/s10554-013-0246-2

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  • DOI: https://doi.org/10.1007/s10554-013-0246-2

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