Association of Impaired Relaxation Mitral Inflow Pattern (Grade 1 Diastolic Function) With Long-Term Noncardiovascular and Cardiovascular Mortality - 01/05/25
, Richard J. Rodeheffer, MD, Jared G. Bird, MD, William R. Miranda, MD, Horng H. Chen, MB, BCh, Jae K. Oh, MD, Garvan C. Kane, MD, PhDAbstract |
Background |
Abnormalities of left ventricular diastolic function are established independent predictors of heart failure and mortality. The aim of this study was to determine whether the association of diastolic function with all-cause mortality is driven by cardiovascular or noncardiovascular death and if impaired relaxation mitral inflow filling pattern is a risk marker.
Methods |
Diastolic function was graded by the Mayo Clinic algorithm using the well-characterized prospective Olmsted County Heart Function Study. Those with reduced left ventricular ejection fraction, moderate or greater valve disease, clinical diagnosis of heart failure, or indeterminate diastolic function were excluded. Notably, all patients with an impaired relaxation pattern (E/A ratio < 0.8) were classified as abnormal (grade 1) regardless of ejection fraction and clinical or other echocardiographic abnormalities. Individuals were followed for a median of 19.7 years (interquartile range, 18.9-20.6 years) for mortality outcomes.
Results |
In a community cohort of 1,005 subjects 63 years (interquartile range, 57-71 years) of age, grade 1 diastolic function was common (26%) and associated with all-cause mortality (hazard ratio [HR], 4.05; 95% CI, 3.22-5.09; P < .0001). This association persisted in a subgroup of those with impaired myocardial relaxation and no other clinical or echocardiographic abnormalities (HR, 2.71; 95% CI, 1.89-3.88; P < .0001). The association of diastolic function with noncardiovascular death was not significant after adjustment for age, sex, and comorbidities, though there was an association with grade 1 diastolic function and risk for death of dementia (age- and sex-adjusted HR, 2.30; 95% CI, 1.54-3.45; P < .001). The association of diastolic function and cardiovascular mortality persisted in multivariable model, including for grade 1 diastolic function (HR, 2.43; 95% CI, 1.16-5.05; P = .02).
Conclusions |
Impaired relaxation mitral inflow pattern (grade 1) is common in older adults in the community and found to be associated with cause-specific death, highlighting this simple echocardiographic finding as a potential biomarker of cardiovascular and cognitive risk and not necessarily a benign finding that is normal with age.
Le texte complet de cet article est disponible en PDF.Central Illustration |
Clinical significance of grade 1 diastolic function. Using a prospective community-based cohort, this study identified that an impaired mitral inflow pattern (grade 1 diastolic function) is common in the community, particularly with older age, and is strongly associated with risk for death of both cardiovascular disease and dementia. This study highlights the importance of grade 1 diastolic function as a valuable marker of risk independent of age, sex, and common clinical comorbidities.
Clinical significance of grade 1 diastolic function. Using a prospective community-based cohort, this study identified that an impaired mitral inflow pattern (grade 1 diastolic function) is common in the community, particularly with older age, and is strongly associated with risk for death of both cardiovascular disease and dementia. This study highlights the importance of grade 1 diastolic function as a valuable marker of risk independent of age, sex, and common clinical comorbidities.
Central IllustrationClinical significance of grade 1 diastolic function. Using a prospective community-based cohort, this study identified that an impaired mitral inflow pattern (grade 1 diastolic function) is common in the community, particularly with older age, and is strongly associated with risk for death of both cardiovascular disease and dementia. This study highlights the importance of grade 1 diastolic function as a valuable marker of risk independent of age, sex, and common clinical comorbidities.Le texte complet de cet article est disponible en PDF.
Highlights |
• | Grade 1 diastolic function is common in the community, particularly with older age. |
• | Grade 1 diastolic function is associated with death of CV causes and dementia. |
• | Grade 1 diastolic function is a valuable independent marker of patient-specific risk. |
Keywords : Diastolic dysfunction, Diastolic function, Impaired myocardial relaxation, Mortality outcomes
Abbreviations : ASE, CAD, DM, EACVI, HF, HFpEF, HR, HTN, LV, LVEF, LVH, OCHFS
Plan
| This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under award R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Further support was provided by National Institutes of Health grant RO1-55502 awarded to Dr. Rodeheffer and National Heart, Lung, and Blood Institute grant R01HL136440 awarded to Dr Chen. |
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| Sheldon E. Litwin, MD, served as guest editor for this report. |
Vol 38 - N° 5
P. 367-377 - mai 2025 Retour au numéro
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