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?

Marzia Rigolli, Andrea Rossi, Miguel Quintana, Allan L. Klein, Cheuk Man Yu, Stefano Ghio, Frank L. Dini, David Prior, Richard W. Troughton, Pier L. Temporelli, Katrina K. Poppe, Robert N. Doughty, Gillian A. Whalley

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)362-368
Number of pages7
JournalInternational Journal of Cardiology
Volume181
DOIs
Publication statusPublished - Feb 15 2015

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Heart Failure
Myocardial Infarction
Survival
Mortality
Echocardiography
Kaplan-Meier Estimate
Survival Analysis
Stroke Volume
Meta-Analysis
Prospective Studies
Pathology
Research

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 journalArticle

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. / 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?. In: International Journal of Cardiology. 2015 ; Vol. 181. pp. 362-368.
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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.",
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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

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