Moderate and severe diastolic dysfunction independently predicted cardiovascular death or heart failure hospitalization compared to normal or mild dysfunction (18% vs. 5%; P<0.01).
RCT (n=312)
Does moderate to severe diastolic dysfunction predict cardiovascular death or heart failure hospitalization in patients with heart failure and preserved systolic function?
Moderate and severe diastolic dysfunction are strong, independent predictors of adverse cardiovascular outcomes in patients with heart failure and preserved ejection fraction.
Effect estimate: HR 3.7 (95% CI 1.2 to 11.1)
Absolute Event Rate: 18% vs 5%
p-value: p=0.003
OBJECTIVES: We tested the hypothesis that diastolic dysfunction (DD) was an important predictor of cardiovascular (CV) death or heart failure (HF) hospitalization in a subset of patients (ejection fraction EF >40%) in the CHARM-Preserved study. BACKGROUND: More than 40% of hospitalized patients with HF have preserved systolic function (HF-PSF), suggesting that DD may be responsible for the clinical manifestations of HF. METHODS: Patients underwent Doppler echocardiographic examination that included assessment of pulmonary venous flow or determination of plasma NT-pro-brain natriuretic peptide > or months after randomization to candesartan or placebo. The patients were classified into 1 of 4 diastolic function groups: normal, relaxation abnormality (mild dysfunction), pseudonormal (moderate dysfunction), and restrictive (severe dysfunction). RESULTS: There were 312 patients in the study, mean age was 66 +/- 11 years, EF was 50 +/- 10%, and 34% were women. The median follow-up was 18.7 months. Diastolic dysfunction was found in 67% of classified patients (n = 293), and moderate and severe DD were identified in 44%. Moderate and severe DD had a poor outcome compared with normal and mild DD (18% vs. 5%, p < 0.01). Diastolic dysfunction, age, diabetes, previous HF, and atrial fibrillation were univariate predictors of outcome. In multivariate analysis, moderate (hazard ratio HR 3.7, 95% confidence interval CI 1.2 to 11.1) and severe DD (HR 5.7, 95% CI 1.4 to 24.0) remained the only independent predictors (p = 0.003). CONCLUSIONS: Objective evidence of DD was found in two-thirds of HF-PSF patients. Moderate and severe DD, which were found in less than one-half of the patients, were important predictors of adverse outcome. The results demonstrate the prognostic significance and need for objective evidence of DD in HF-PSF patients.
Persson et al. (Sat,) conducted a rct in Heart Failure With Preserved Systolic Function (n=312). Moderate and severe diastolic dysfunction vs. Normal and mild diastolic dysfunction was evaluated on Cardiovascular death or heart failure hospitalization (HR 3.7, 95% CI 1.2 to 11.1, p=0.003). Moderate and severe diastolic dysfunction independently predicted cardiovascular death or heart failure hospitalization compared to normal or mild dysfunction (18% vs. 5%; P<0.01).
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