Abstract 13816: Prediction of Risk for Cardiovascular Events in Patients with Preserved Left Ventricular Ejection Fraction: Incremental Value of Diastolic Wall Strain
Background: Diastolic wall strain (DWS) was recently reported as a simple and feasible echocardiographic index in assessing left ventricular diastolic stiffness. We sought to evaluate whether DWS independently predicts cardiovascular (CV) events in patients with preserved ejection fraction (EF), and whether it is incremental to conventional risk factors for identifying patients at increased risk for future CV events.
Methods: Consecutive patients referred for clinically-indicated echocardiogram, those with preserved EF and no clinical heart failure or cardiac structural abnormalities were studied. CV events were ascertained using Framingham criteria (myocardial infarction, coronary insufficiency, stroke, transient ischemic attack, congestive heart failure, or CV death). DWS was calculated with a validated formula. Cox proportional hazards modeling was used to assess risk of CV events.
Results: Of a total number of 962 patients (61 ± 15 year-old, 48% men, 50% hypertension, 18% diabetes), 69 (7.2%) developed CV event during a mean follow-up of 43 ± 32 months. CV events were significantly increased with advancing age (HR 1.4, 95%CI 1.1-1.7) and male sex (HR 2.4, 95%CI 1.4-4.1). After adjusting for comorbidities in a multivariate model, higher pulse pressure (HR 1.3, 95%CI 1.1-1.5), lower 1/creatinine (HR 0.4, 95%CI 0.2-0.6), diabetes (HR 2.2, 95%CI 1.3-3.8), prior coronary artery disease (HR 2.3, 95%CI 1.3-3.9), and larger left atrial volume index (HR 1.3, 95%CI 1.1-1.6) were independent predictors of CV events. Further, low-DWS (≦0.33) was a significant predictor of CV events independent of other comorbidities (HR 2.0, 95% CI 1.1-3.6). The predictive power of the models showed that DWS added significantly to conventional risk factors for CV outcome prediction (Fig.).
Conclusion: Echocardiographic assessment of DWS provides prognostic information for the prediction of future CV events, independently of and incrementally to conventional risk factors.
Author Disclosures: S. Tsujimoto: None. Y. Miyasaka: None. Y. Suwa: None. H. Maeba: None. K. Yamamoto: None. I. Shiojima: None.
- © 2014 by American Heart Association, Inc.