Prognostic Significance of the Left Ventricular Diastolic Score: A Project Baseline Health Study

Introduction Left ventricular diastolic dysfunction (LVDD) is an important predictor of cardiovascular outcomes. To date, however, few studies have validated the prognostic value of the LVDD assessment guidelines in a community-based setting. This study aimed to validate the predictive significance of LVDD following recommendations from the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI), and to explore the use of a diastolic score in characterizing LVDD, particularly in individuals who remain unclassified (indeterminate) by the guidelines. Materials and Methods Project Baseline Health Study (PBHS) participants were included (n=1,952). LVDD was graded using the ASE/EACVI criteria. Multivariable Cox regression estimated associations between LVDD and major adverse cardiovascular events (MACE). To gain insights into the indeterminate group, we developed a novel diastolic score (0-6 points) with minor and major criteria guided by percentile deviation from a healthy reference cohort (n=565), including early mitral annular tissue Doppler velocity (e’), the ratio of early diastolic inflow velocity to e’ (E/e’), and left atrial volume index. Results At enrollment, the mean age of participants was 50±16; and 56% were female. According to the ASE/EACVI guidelines, LVDD was indeterminate in 5.9% and present in 8.4% of participants, of whom 54.3% had an indeterminate LVDD grade. Age, hypertension, diabetes mellitus, and cardiovascular disease were strongly associated with LVDD. Using the PBHS diastolic score, scores ≥3 and ≥4 were observed in 14.1% and 5.8% of the population, respectively. ASE/EACVI grades 2-3 corresponded with scores ≥4, whereas indeterminate categories corresponded with scores of 1-5. After multivariable adjustment, both LVDD grading systems predicted MACE (ASE/EACVI grade indeterminate and grades 2-3: aHRs 2.49 [95%CI: 1.39-4.46] and 5.7 [95%CI: 3.01-10.7], respectively; PBHS scores 4 and 5-6: aHRs 2.3 [95%CI: 1.25-4.33] and 5.3 [95%CI: 2.44-11.56], respectively). Conclusions This study validated the prognostic value of the ASE/EACVI diastolic function guidelines in the community. Assessing LVDD using a diastolic score free of indeterminate classifications may be worth exploring in future studies. ClinicalTrials.gov Identifier NCT03154346