Prevalence and Outcome of Advanced Left Ventricular Diastolic Dysfunction among Consecutive Patients Referred for Echocardiography

Abstract

Aim: To assess the prevalence of advanced left ventricular diastolic dysfunction (LVDD) in a cohort of consecutive patients referred for echocardiography and its association with mortality. Methods: The cohort included 4,481 (85% hospitalized) patients who underwent echocardiography, had normal or preserved LV systolic function and diastolic function assessment. LVDD was graded as none or mild (0/I) and advanced grade (II/III). Mortality data were derived from the National Israeli Population Registry. Results: LVDD grade II/III was found in 1,262 patients (28%), was more prevalent among the elderly, females, diabetic and hypertensive patients. Independent predictors associated with LVDD grade II/III (OR; 95% CI) were: age (1-year increment) 1.015 (1.01-1.02), p<0.001; female sex 1.2 (1.04-1.39), p=0.012; hypertension 1.53 (1.30-1.80), p<0.001, while ischaemic heart disease was negatively associated 0.73 (0.63- 0.85), p<0.001. 1-year mortality rates were higher among grade II/III LVDD as compared to grade 0/I DD patients, 19% vs. 10.2%, respectively, p<0.0001. Independent predictors for all-cause mortality after adjusting for pertinent variables were: LVDD grade II/III 1.72 (1.40-2.11); age (1-year increment) 1.08 (1.07-1.09) and diabetes 1.54 (1.26-1.70), p<0.001 for all. Conclusion: LVDD grade II/III was more prevalent among the elderly, females, diabetic and hypertensive patients. Advanced LVDD was a strong independent predictor for all-cause mortality after adjustment for risk factors. Intensive pharmacological therapies at an earlier stage of LVDD may improve patients’ outcome.