Key result
Grade III diastolic dysfunction by the 2016 algorithm was associated with a higher incidence of cardiovascular death or HF readmission compared to Grade I (HR 1.89; 95% CI 1.17-3.04; P=0.009).
Why the study?
Although left ventricular diastolic dysfunction has prognostic significance in HF, the impact of the updated 2016 echocardiographic algorithm on post-discharge outcomes in acute HF compared with the 2009 algorithm remained to be assessed.
Does the 2016 ASE/EACVI algorithm for left ventricular diastolic dysfunction (DD2016) provide comparable prognostic value to the 2009 algorithm (DD2009) for predicting cardiovascular death and HF readmission in patients hospitalized for acute decompensated HF?
Cohort (n=481)
Does the 2016 ASE/EACVI algorithm for left ventricular diastolic dysfunction (DD2016) provide comparable prognostic value to the 2009 algorithm (DD2009) for predicting cardiovascular death and HF readmission in patients hospitalized for acute decompensated HF?
The simplified 2016 ASE/EACVI algorithm for evaluating left ventricular diastolic dysfunction maintains prognostic value for post-discharge cardiovascular events in acute heart failure patients, comparable to the 2009 algorithm.
Answers are grounded in this paper and cite their sources.
Supports prognostic use of 2016 DD grading post-ADHF discharge; leaves open whether it matches 2009 algorithm performance.
AIMS: Left ventricular diastolic dysfunction (LVDD) has prognostic significance in heart failure (HF). We aimed to assess the impact of LVDD grade stratified by the updated 2016 echocardiographic algorithm (DD2016) on post-discharge outcomes in patients admitted for acute HF and compare with the previous 2009 algorithm (DD2009). METHODS AND RESULTS: The study included 481 patients hospitalized for acute decompensated HF. Comprehensive echocardiography and LVDD evaluation were performed just before hospital discharge. The primary endpoint was a composite of cardiovascular death and readmission for HF. The concordance between DD2016 and DD2009 was moderate (κ = 0.44, P < 0.001); the reclassification rate was 39%. During the follow-up (median: 15 months), 127 (26%) patients experienced the primary endpoint. In the Kaplan-Meier analysis, Grade III in DD2016 showed a lower event-free survival rate than Grades I and II (log rank, P < 0.001 and P = 0.048, respectively) and was independently associated with a higher incidence of the primary endpoint than Grade I [hazard ratio 1.89; 95% confidence interval (CI) 1.17-3.04; P = 0.009]. Grade II or III in DD2016, reflecting elevation of left ventricular (LV) filling pressure, added an incremental predictive value of the primary endpoint to clinical variables irrespective of LV ejection fraction. DD2016 was comparable to DD2009 in predicting the endpoint (net reclassification improvement = 11%; 95% CI -7% to 30%, P = 0.23). CONCLUSION: Despite simplification of the algorithm for LVDD evaluation, the prognostic value of DD2016 for post-discharge cardiovascular events in HF patients was maintained and not compromised in comparison with DD2009.
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Machino‐Ohtsuka et al. (2019) conducted a cohort in Acute decompensated heart failure (n=481). Grade III diastolic dysfunction by 2016 ASE/EACVI algorithm (DD2016) vs. Grade I diastolic dysfunction was evaluated on Composite of cardiovascular death and readmission for heart failure (HR 1.89, 95% CI 1.17-3.04, p=0.009). Grade III diastolic dysfunction by the 2016 algorithm was associated with a higher incidence of cardiovascular death or HF readmission compared to Grade I (HR 1.89; 95% CI 1.17-3.04; P=0.009).
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