title: Incremental prognostic value of diastolic dysfunction in low risk patients undergoing echocardiography: beyond Framingham score.
abstract: We sought to assess the prognostic value of diastolic dysfunction (DD) in low-risk adults beyond Framingham risk score (FRS). Consecutive patients without cardiovascular risk factors or co-morbidities were identified from a retrospective cohort. Multivariate binary logistic regression was performed to identify factors associated with DD, and Cox proportional hazard model to evaluate the association of DD with all-cause death. Analysis was repeated by stratifying by the year of the echocardiogram to account for possible time-related shift in measurement techniques. Net reclassification improvement (NRI) was performed to assess incremental prognostic value of DD. The study cohort consisted on 1,039 patients with a mean age (SD) 47.9 (15.7) years. Overall, 346 patients (33.3 %) had DD, among whom 327 were grade 1. Age was the only independent predictor of DD with odds ratio 3.2 (2.8; 3.7) for every 10 years increase (p < 0.0001). After a mean follow-up time (SD) of 7.3 (1.7) years, 71 (6.8 %) patients died. Adjusting for age, gender, and race, DD remained an independent predictor of all-cause mortality with hazard ratio (95 % CI) 2.03 (p = 0.029), and similarly after adjusting for FRS (HR 2.73, p = 0.002) which resulted in IDI gain of 1.4 % (p = 0.0037) and NRI of 15 % (p = 0.029). In 463 age and gender matched subgroups, DD was still an independent predictor of mortality (HR 2.6 [1.25; 5.55], p = 0.01). In low-risk adult outpatients undergoing echocardiography, DD was associated with 2-3 fold increase in risk of death and had incremental prognostic value beyond FRS.
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA, wa53@aub.edu.lb.
authors.forename: Wael A
authors.initials: WA
authors.lastname: AlJaroudi
authors.forename: M Chadi
authors.initials: MC
authors.lastname: Alraies
authors.forename: Carmel
authors.initials: C
authors.lastname: Halley
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.forename: L Leonardo
authors.initials: LL
authors.lastname: Rodriguez
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grimm
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Wael A
authors.initials: WA
authors.lastname: Jaber
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003971:Diastole; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D016277:Ventricular Function, Left