title: The prognostic value of the mitral diastolic filling velocity ratio for all-cause mortality and cardiovascular morbidity in African Americans: the Atherosclerotic Risks in Communities (ARIC) study.
abstract: BACKGROUND
  Although recent data suggest that the mitral diastolic early-to-late (E/A) ratio may be prognostic in selected population-based cohorts, its predictive value for morbidity and mortality in African Americans has not yet been well studied.
  
  
  METHODS
  The study population consisted of African American participants from the Jackson cohort of the Atherosclerotic Risks in Community Study. Three subgroups of E/A ratios were defined: E/A <0.7, E/A 0.7-1.5, and E/A >1.5, using the middle group as reference. Cox proportional hazard models were used to assess the association between the E/A ratio and both all-cause mortality and incident cardiovascular disease (CVD). The mean follow-up period was 6.8 +/- 1.3 years.
  
  
  RESULTS
  Of the 2211 participants in the study population (mean age 62 years, 65.1% women), 8.2% had an E/A ratio <0.7, 84.7% had an E/A 0.7-1.5, and 7.1% had an E/A >1.5. An E/A >1.5 was independently associated with all-cause mortality (hazard ratio [HR] 2.18, 95% confidence interval [CI] 1.20-4.03) in the multivariable model. An E/A <0.7 was associated with higher all-cause mortality (HR 1.79, 95% CI 1.17-2.73) and incident CVD (HR 1.91, 95% CI 1.29-2.83) compared with a normal E/A in the age and sex adjusted model but was not independently predictive in the multivariable model (P > .05).
  
  
  CONCLUSIONS
  In a population-based cohort of middle-aged African Americans, an E/A >1.5 independently predicts all-cause mortality. An E/A >1.5 and an E/A <0.7 were both associated with incident CVD when adjusted for age and sex alone but were not independently predictive in the multivariable analysis.
authors.affiliation: NHLBI's Atherosclerotic Risk in Communities Study, Jackson, MS, USA. efox@medicine.umsmed.edu
authors.forename: Ervin R
authors.initials: ER
authors.lastname: Fox
authors.forename: Hui
authors.initials: H
authors.lastname: Han
authors.forename: Herman A
authors.initials: HA
authors.lastname: Taylor
authors.forename: Ulysses C
authors.initials: UC
authors.lastname: Walls
authors.forename: Tandaw
authors.initials: T
authors.lastname: Samdarshi
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Skelton
authors.forename: Jun
authors.initials: J
authors.lastname: Pan
authors.forename: Donna
authors.initials: D
authors.lastname: Arnett
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D050197:Atherosclerosis / Q000209:etiology; D001783:Blood Flow Velocity; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003971:Diastole; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology*; D009026:Mortality; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment