Abstract 17590: Diastolic Function Assessment Has an Independent and Incremental Value in Patients with Advanced Ischemic Cardiomyopathy - A Current Appraisal of an Old Question

Abstract

BACKGROUND: Diastolic function (DF) has important prognostic value in patients preserved systolic function. Limited information is available in those with ischemic cardiomyopathy particularly in the current era medical and device therapy. Furthermore, whether it has incremental value to that provided by cardiac magnetic resonance (CMR) remains unknown.

HYPOTHESIS: We hypothesized that DF assessment in patients with advanced ischemic cardiomyopathy has an independent and incremental value for prognostication of all-cause mortality over clinical, echocardiographic and CMR data (ie: LV volumes, LVEF, sphericity, scar location and extent).

METHODS: A total of 354 patients with LVEF ≤ 40% and ≥ 70% stenosis in ≥1 coronary artery but without prior mitral valve surgery, fused E/A waves, atrial fibrillation or > moderate mitral regurgitation were included. Patients were selected if they had undergone TTE and CMR studies within 7 days (median=1 day). Charts were reviewed for demographic data, medications, and procedures including revascularization and device therapy. DF assessment was performed as per ASE guidelines. Cox proportional hazards modeling for all-cause mortality was used to risk-adjust comparisons.

RESULTS: Males represented 76% of the cohort with a mean age of 62 ± 10 years. Mean LVEF was 23 ± 0.5% and DF was classified as either: stage 1 (44%), stage 2 (25%) or stage 3 (31%). Over a mean follow-up time of 5.5 yrs (max 9.5 yrs) there were 148 deaths (42%). Cox proportional hazards modeling revealed that DF (> stage 1) had not only an independent (HR=1.28, p=0.003) but also incremental value to the prediction of all-cause mortality after adjustments for clinical, echocardiographic and CMR data (Model X² increased from 120 to 124, p < 0.0001) (Figure)

CONCLUSION: Assessment of DF in patients with advanced ischemic cardiomyopathy is very important providing independent and incremental value to clinical, echocardiographic and CMR data.