Abstract | BACKGROUND: Diastolic dysfunction (DD) might help to risk stratify patients with heart failure (HF) with reduced ejection fraction (HFrEF). Nonetheless, HF guidelines/risk scores don't consider DD. We aimed to show the independent prognostic value of DD for nonfatal HF/death in patients with HFrEF on top of natriuretic peptides (NP). METHODS: We analyzed 1155 baseline echocardiograms of the MADIT-CRT study (LVEF≤30%, QRS ≥ 130 ms, NYHA class I/II), classifying DD according to 2016 ASE/EACVI classification. RESULTS: Patients were 64 ± 11 years-old, 24% females, LVEF was 24 ± 5%, 58% had abnormal BNP (≥100 pg/ml). While 45% had impaired relaxation, 33% had pseudonormal filling, 12% restrictive pattern, 6% indeterminate diastolic function, 4% were not classifiable due to missing data. During a follow-up of 2.1 ± 1.0 years, there were 233 HF/death. Compared to patients without pseudonormal/restrictive filling and with normal NP (23%), patients with pseudonormal/restrictive filling, alone (15%) or combined to elevated NP (30%), were at higher risk of events (respectively padj = 0.025 and padj < 0.001), as opposed to those with abnormal NP alone (22%; padj = 0.55). Adding DD to conventional markers of risk and NP improved prediction (C-statistic 0.733 versus 0.708, p = 0.024). DD was the first parameter to be considered to risk stratify MADIT-CRT population, according to Classification-And-Regression-Tree analysis. CONCLUSIONS: Among HFrEF patients with mild symptoms, pseudonormal/restrictive filling, either alone or combined with elevated NP, was associated with high risk of events, as opposed to isolated elevation of NP. DD provided incremental risk prediction for death/HF beyond commonly used markers. These data might suggest to integrate DD into HF guidelines/risk scores.
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Authors | Mauro Gori, Brian Claggett, Michele Senni, Amil M Shah, Ilan Goldenberg, Valentina Kutyifa, Dorit Knappe, Ann-Catherine Pouleur, Scott D Solomon |
Journal | International journal of cardiology
(Int J Cardiol)
Vol. 335
Pg. 59-65
(07 15 2021)
ISSN: 1874-1754 [Electronic] Netherlands |
PMID | 33887340
(Publication Type: Journal Article)
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Copyright | Copyright © 2021 Elsevier B.V. All rights reserved. |
Chemical References |
- Natriuretic Peptides
- Natriuretic Peptide, Brain
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Topics |
- Aged
- Diastole
- Female
- Heart Failure
(diagnostic imaging)
- Humans
- Male
- Middle Aged
- Natriuretic Peptide, Brain
- Natriuretic Peptides
- Stroke Volume
- Ventricular Dysfunction, Left
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