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 65 years, 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.
| Original language | English |
|---|---|
| Pages (from-to) | 362-368 |
| Number of pages | 7 |
| Journal | International Journal of Cardiology |
| Volume | 181 |
| DOIs | |
| Publication status | Published - Feb 15 2015 |
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Keywords
- Diastole
- Echocardiography
- Heart failure
- Meta-analysis
- Mortality
- Myocardial infarction
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Medicine(all)
Cite this
The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction : Can age-stratified E/A ratio alone predict survival? / Rigolli, Marzia; Rossi, Andrea; Quintana, Miguel; Klein, Allan L.; Yu, Cheuk Man; Ghio, Stefano; Dini, Frank L.; Prior, David; Troughton, Richard W.; Temporelli, Pier L.; Poppe, Katrina K.; Doughty, Robert N.; Whalley, Gillian A.
In: International Journal of Cardiology, Vol. 181, 15.02.2015, p. 362-368.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction
T2 - Can age-stratified E/A ratio alone predict survival?
AU - Rigolli, Marzia
AU - Rossi, Andrea
AU - Quintana, Miguel
AU - Klein, Allan L.
AU - Yu, Cheuk Man
AU - Ghio, Stefano
AU - Dini, Frank L.
AU - Prior, David
AU - Troughton, Richard W.
AU - Temporelli, Pier L.
AU - Poppe, Katrina K.
AU - Doughty, Robert N.
AU - Whalley, Gillian A.
PY - 2015/2/15
Y1 - 2015/2/15
N2 - 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 65 years, 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.
AB - 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 65 years, 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.
KW - Diastole
KW - Echocardiography
KW - Heart failure
KW - Meta-analysis
KW - Mortality
KW - Myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=84947202080&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84947202080&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2014.12.051
DO - 10.1016/j.ijcard.2014.12.051
M3 - Article
C2 - 25555281
AN - SCOPUS:84947202080
VL - 181
SP - 362
EP - 368
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -