Severe diastolic dysfunction was independently associated with increased all-cause mortality in patients with HFrEF (HR 1.347, P=0.015) and HFmrEF (HR 1.358, P=0.046) compared to non-severe DD.
Cohort (n=2,018)
Does severe diastolic dysfunction increase mortality in heart failure patients with mid-range or reduced ejection fraction?
Echocardiography-defined severe diastolic dysfunction is an independent predictor of all-cause mortality in patients with both mid-range and reduced ejection fraction heart failure.
Effect estimate: HR 1.347 (HFrEF); HR 1.358 (HFmrEF)
p-value: p=0.015 (HFrEF); 0.046 (HFmrEF)
AIMS: The role of diastolic dysfunction (DD) in prognostic evaluation in heart failure (HF) patients with impaired systolic function remains unclear. We investigated the impact of echocardiography-defined DD on survival in HF patients with mid-range (HFmrEF, EF 41-49%) and reduced ejection fraction (HFrEF, EF < 40%). METHODS AND RESULTS: A total of 2018 consecutive hospitalized HF patients were retrospectively included and divided in two groups based on baseline EF: HFmrEF group (n = 951, aged 69 ± 13 years, 74.2% male) and HFrEF group (n = 1067, aged 68 ± 13 years, 76.3% male). Clinical data were collected and analysed. All patients completed ≥1 year clinical follow-up. The primary endpoint was defined as all-cause death (including heart transplantation) and cardiovascular (CV)-related death. All-cause mortality (30.8% vs. 24.9%, P = 0.003) and CV mortality (19.1% vs. 13.5%, P = 0.001) were significantly higher in the HFrEF group than the HFmrEF group during follow-up median 24 (13-36) months. All-cause mortality increased in proportion to DD severity (mild, moderate, and severe) in either HFmrEF (17.1%, 25.4%, and 37.0%, P < 0.001) or HFrEF (18.9%, 30.3%, and 39.2%, P < 0.001) patients. The risk of all-cause mortality hazard ratio (HR) = 1.347, P = 0.015 and CV mortality (HR = 1.508, P = 0.007) was significantly higher in HFrEF patients with severe DD compared with non-severe DD after adjustment for identified clinical and echocardiographic covariates. For HFmrEF patients, severe DD was independently associated with increased all-cause mortality (HR = 1.358, P = 0.046) but not with CV mortality (HR = 1.155, P = 0.469). CONCLUSIONS: Echocardiography-defined severe DD is independently associated with increased all-cause mortality in patients with HFmrEF and HFrEF.
Liu et al. (Sat,) conducted a cohort in Heart failure with mid-range or reduced ejection fraction (n=2,018). Severe diastolic dysfunction vs. Non-severe diastolic dysfunction was evaluated on All-cause death (including heart transplantation) and cardiovascular (CV)-related death (HR 1.347 (HFrEF); HR 1.358 (HFmrEF), p=0.015 (HFrEF); 0.046 (HFmrEF)). Severe diastolic dysfunction was independently associated with increased all-cause mortality in patients with HFrEF (HR 1.347, P=0.015) and HFmrEF (HR 1.358, P=0.046) compared to non-severe DD.