title: The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction: Can age-stratified E/A ratio alone predict survival?
abstract: OBJECTIVE
  To determine the prognostic implications of diastolic filling grades and identify whether age-stratified E/A ratio alone can identify patients at high risk of death post-AMI and HF. We hypothesized that in response to ageing and pathology, a normal E/A (>1) could be considered abnormal in patients post-AMI older than 65years, and that in patients with symptomatic HF, a normal E/A always represents advanced diastolic dysfunction.
  
  
  RESULTS
  This is a sub-analysis of the Meta-analysis Research Group in Echocardiography (MeRGE) which combined individual patient data from 30 prospective studies and demonstrated that restrictive filling was an important and independent predictor of all-cause mortality. This sub-analysis is restricted to those studies in which continuous E/A data were available (20 studies) and includes a total of 3082 AMI and 2321 HF patients. Patients were classified at the time of echocardiography into four filling patterns: normal, abnormal relaxation, pseudonormal, and restrictive filling. Post-AMI patients were divided into four groups on the basis of age and E/A, while patients with HF were classified into three groups, based on only E/A. Mortality across groups was compared using Kaplan-Meier survival analysis and Cox proportional hazards. In multivariable analyses in the AMI patients, age-stratified E/A was an independent predictor of outcome (HR 1.43 (95% CI: 1.31-1.56)), and in the HF cohort, E/A was confirmed as an independent predictor of mortality (HR 1.12 (95% CI 1.09-1.16)) alongside age and ejection fraction.
  
  
  CONCLUSIONS
  Age-stratified E/A is an independent predictor of mortality after AMI and in HF patients, regardless of left ventricular ejection fraction, age and gender. E/A ratio could be a first step echocardiographic risk stratification, which could precede and indicate the need for more advanced diagnostic and prognostic considerations in high-risk AMI and HF patients.
authors.affiliation: Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; University of Verona, Verona, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Rigolli
authors.affiliation: University of Verona, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Karolinska Institute, Sweden.
authors.forename: Miguel
authors.initials: M
authors.lastname: Quintana
authors.affiliation: Cleveland Clinic Foundation, OH, USA.
authors.forename: Allan L
authors.initials: AL
authors.lastname: Klein
authors.affiliation: Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.affiliation: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.affiliation: Santa Chiara Hospital, University of Pisa, Pisa, Italy.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Dini
authors.affiliation: St Vincents Hospital, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Prior
authors.affiliation: Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Troughton
authors.affiliation: Fondazione Salvatore Maugeri, IRCCS, Veruno (Italy).
authors.forename: Pier L
authors.initials: PL
authors.lastname: Temporelli
authors.affiliation: Department of Medicine, University Of Auckland, Auckland, New Zealand.
authors.forename: Katrina K
authors.initials: KK
authors.lastname: Poppe
authors.affiliation: Department of Medicine, University Of Auckland, Auckland, New Zealand.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
authors.affiliation: Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; Unitec Institute of Technology, Auckland, New Zealand. Electronic address: gwhalley@unitec.ac.nz.
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whalley
mesh_terms: D000375:Aging / Q000473:pathology*; D002908:Chronic Disease; D003971:Diastole; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Diastole; Echocardiography; Heart failure; Meta-analysis; Mortality; Myocardial infarction