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European Radiology

, Volume 30, Issue 1, pp 630–639 | Cite as

Application of the newest European Association of Cardiovascular Imaging Recommendation regarding the long-term prognostic relevance of left ventricular diastolic function in heart failure with preserved ejection fraction

  • Ting-Tse Lin
  • Yi-Chih Wang
  • Jyh-Ming Jimmy Juang
  • Juey-Jen Hwang
  • Cho-Kai WuEmail author
Cardiac
  • 69 Downloads

Abstract

Objective

The long-term predictive value of the new proposed algorithm in the updated 2016 guidelines of the European Association of Cardiovascular Imaging to assess diastolic dysfunction (DD) in patients with heart failure with preserved ejection fraction (HFpEF) has not been validated.

Methods

The analysis included 451 patients who were diagnosed with HFpEF as confirmed via echocardiography. The endpoints were mortality and hospitalization for HF. The Kaplan–Meier curves and Cox regression models were generated to determine the risk of all-cause mortality based on the 2016 and 2009 DD grading algorithm, respectively. We evaluated the net reclassification index of outcomes on the basis of 2009 DD grade after abiding by the 2016 recommendations.

Results

After a follow-up of 2976 days, 119 patients (26.4%) died. According to the 2016 DD grading, grade III DD was associated with a significantly higher risk of mortality (hazard ratio [HR], 2.209; 95% CI 1.144–4.266) and HF hospitalization (HR, 2.047; 95% CI 1.348–3.870), as compared with grade I DD. Grade II DD was also associated with a higher risk of mortality (HR, 1.538; 95% CI 1.313–1.924). However, only grade III DD was independently associated with worse mortality based on 2009 DD grading. The net reclassification index for mortality increased significantly after grading by 2016 algorithm (10.6%, p < 0.001).

Conclusions

The 2016 DD grading algorithm showed improved prognostic value of long-term mortality in patients with HFpEF. Based on the findings of the study, the appropriate grading of DD is important in the prognostication of patients with HFpEF.

Key Points

• The application of the 2016 European Association of Cardiovascular Imaging recommendations diastolic dysfunction (DD) grading algorithm improves the predictive value for mortality.

• Our analysis suggests DD grades II and III based on 2016 guidelines is associated with poor outcomes as compared with grade I. The echocardiographic indices of the new algorithm should be obtained and applied to effectively evaluate DD.

Keywords

Left-sided heart failure Transthoracic echocardiography Mortality 

Abbreviations

ACEI

Angiotensin-converting enzyme inhibitors

ARB

Angiotensin II receptor blockers

ASE

American Society of Echocardiography

CCB

Calcium channel blockers

CI

Confidence interval

DD

Diastolic dysfunction

EACVI

European Association of Cardiovascular Imaging

HFpEF

Heart failure with preserved ejection fraction

HR

Hazard ratio

I-PRESERVE

Irbesartan in Heart Failure With Preserved Ejection Fraction

LAP

Left atrial pressure

LAVI

Left atrium volume index

LVDD

Left ventricular diastolic dysfunction

MACE

Major cardiovascular events

NYHA

New York Heart Association

PCWP

Pulmonary capillary wedge pressure

ROC

Receiver operating characteristic

RV

Right ventricular

SHF

Systolic heart failure

TDHFR

Taiwan Diastolic Heart Failure Registry

TR

Tricuspid regurgitation

TRPG

Tricuspid regurgitation pressure gradient

Notes

Funding

This work was supported, in part, by the IBMS CRC Research Program of Institute of Biomedical Science, Academia Sinica (IBMS-CRC99-P02), and grants (NSC 99-2314-B-002-131-MY3, NSC 100-2341-B-002-160-) from the National Science Council of R.O.C.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Cho-Kai Wu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Observational

• Performed at one institution

Supplementary material

330_2019_6261_MOESM1_ESM.docx (24 kb)
ESM 1 (DOCX 23 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Internal MedicineNational Taiwan University College of Medicine and Hospital Hsin-Chu BranchHsin-Chu CityTaiwan
  2. 2.Division of Cardiology, Department of Internal MedicineNational Taiwan University College of Medicine and HospitalTaipeiTaiwan

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