Diastolic dysfunction revisited: A new, feasible, and unambiguous echocardiographic classification predicts major cardiovascular events
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Diastolic dysfunction revisited : A new, feasible, and unambiguous echocardiographic classification predicts major cardiovascular events. / Johansen, Niklas Dyrby; Biering-Sørensen, Tor; Jensen, Jan Skov; Mogelvang, Rasmus.
In: American Heart Journal, Vol. 188, 06.2017, p. 136-146.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Diastolic dysfunction revisited
T2 - A new, feasible, and unambiguous echocardiographic classification predicts major cardiovascular events
AU - Johansen, Niklas Dyrby
AU - Biering-Sørensen, Tor
AU - Jensen, Jan Skov
AU - Mogelvang, Rasmus
N1 - Copyright © 2017 Elsevier Inc. All rights reserved.
PY - 2017/6
Y1 - 2017/6
N2 - BACKGROUND: Echocardiographic classification of DDF has been widely discussed. The aim of this study was to investigate the independent prognostic value of established echocardiographic measures in a community-based population and create a new classification of DDF.METHODS: Within the Copenhagen City Heart Study, a prospective, community-based study, 1851 participants were examined by echocardiography including Tissue Doppler Imaging (TDI) in 2001 to 2003 and followed with regard to MACE (median, 10.9 years).RESULTS: We found that persons with impaired myocardial relaxation as defined by low peak early diastolic mitral annular velocity e' by TDI had higher incidence of clinical and echocardiographic markers of cardiac dysfunction and increased risk of MACE. Among persons with impaired relaxation, only echocardiographic indices of increased filling pressures such as LAVi≥34 mL/m2 (HR 1.97 (1.13-3.45, P=.017), E/e' ≥ 17 (HR 1.89 (1.34-2.65), P<.001), and E/A>2 (HR 5.24 (1.91-14.42), P=.001) provided additional and independent prognostic information on MACE. Based on these findings, we created a new classification of DDF where all grades were significant predictors of MACE independently of age, sex, and cardiac clinical risk markers (Mild DDF: HR 1.99 (1.23-3.21), P=.005; Moderate DDF: HR 3.11 (1.81-5.34), P<.001; Severe DDF: HR 4.20 (1.81-9.73), P<.001). Increasing severity of DDF was linearly associated with increasing plasma proBNP concentrations.CONCLUSIONS: In the general population, the presence of echocardiographic markers of elevated filling pressures in persons with impaired relaxation increased the risk of MACE significantly. Based on this, we present a new, feasible, and unambiguous classification of DDF capable of accurate risk prediction in the community.
AB - BACKGROUND: Echocardiographic classification of DDF has been widely discussed. The aim of this study was to investigate the independent prognostic value of established echocardiographic measures in a community-based population and create a new classification of DDF.METHODS: Within the Copenhagen City Heart Study, a prospective, community-based study, 1851 participants were examined by echocardiography including Tissue Doppler Imaging (TDI) in 2001 to 2003 and followed with regard to MACE (median, 10.9 years).RESULTS: We found that persons with impaired myocardial relaxation as defined by low peak early diastolic mitral annular velocity e' by TDI had higher incidence of clinical and echocardiographic markers of cardiac dysfunction and increased risk of MACE. Among persons with impaired relaxation, only echocardiographic indices of increased filling pressures such as LAVi≥34 mL/m2 (HR 1.97 (1.13-3.45, P=.017), E/e' ≥ 17 (HR 1.89 (1.34-2.65), P<.001), and E/A>2 (HR 5.24 (1.91-14.42), P=.001) provided additional and independent prognostic information on MACE. Based on these findings, we created a new classification of DDF where all grades were significant predictors of MACE independently of age, sex, and cardiac clinical risk markers (Mild DDF: HR 1.99 (1.23-3.21), P=.005; Moderate DDF: HR 3.11 (1.81-5.34), P<.001; Severe DDF: HR 4.20 (1.81-9.73), P<.001). Increasing severity of DDF was linearly associated with increasing plasma proBNP concentrations.CONCLUSIONS: In the general population, the presence of echocardiographic markers of elevated filling pressures in persons with impaired relaxation increased the risk of MACE significantly. Based on this, we present a new, feasible, and unambiguous classification of DDF capable of accurate risk prediction in the community.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Denmark
KW - Diastole
KW - Echocardiography, Doppler
KW - Feasibility Studies
KW - Female
KW - Follow-Up Studies
KW - Forecasting
KW - Heart Failure
KW - Heart Ventricles
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Ventricular Dysfunction, Left
KW - Young Adult
KW - Journal Article
KW - Multicenter Study
U2 - 10.1016/j.ahj.2017.03.013
DO - 10.1016/j.ahj.2017.03.013
M3 - Journal article
C2 - 28577669
VL - 188
SP - 136
EP - 146
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -
ID: 186323681