title: Adverse Cardiac Events and the Impaired Relaxation Left Ventricular Filling Pattern.
abstract: Increasing diastolic dysfunction (DD) grade is associated with increased heart failure (HF). Patients with preserved ejection fractions and grade 1 DD may have left atrial dilatation, e' < 8 cm/sec, increased left ventricular (LV) mass, or variable E/e' ratios. The aim of this study was to test the hypothesis that LV hypertrophy or E/e' ratio > 8 may be associated with a greater incidence of HF.
  
  
  
  Two hundred twelve patients with grade 1 DD and ejection fractions > 50% were retrospectively studied. Group 1 comprised 108 patients with E/A ratios < 0.8, without LV hypertrophy, e' < 8 cm/sec, and E/e' ratios < 8. Group 2 comprised 104 patients with LV hypertrophy or E/e' ratios > 8. Patients with incident HF and valvular or coronary disease were excluded. Using two-dimensional Doppler echocardiography, LV and left atrial volumes and transmitral spectral and tissue Doppler were analyzed. Medical records were examined for laboratory data, HF admissions, and all-cause mortality from 2004 to 2012.
  
  
  
  Despite similar ejection fractions, patients in group 2 had greater LV and left atrial volumes, LV mass index values, and E/e' ratios (P < .01 for all). HF incidence was greater in group 2 (30 vs 4, P < .001). Combined HF or all-cause mortality was greater in group 2 (46 vs 14, P < .001). Multivariate analysis revealed that HF was associated with E/e' ratio (P < .0001), systolic blood pressure (P = .0123), and LV mass index (P = .042). Combined HF or all-cause mortality was associated with E/e' ratio (P < .0001), LV mass index (P = .009), and lower calcium channel blocker use (P = .0011).
  
  
  
  HF alone or HF and all-cause mortality were increased in patients with grade 1 DD in the presence of LV hypertrophy or elevated LV filling pressures.
authors.affiliation: University of Florida-Jacksonville, Jacksonville, Florida; Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee. Electronic address: lavine@etsu.edu.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lavine
authors.affiliation: Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee.
authors.forename: Kais
authors.initials: K
authors.lastname: Al Balbissi
mesh_terms: D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000401:mortality*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D013714:Tennessee / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: Diastolic dysfunction; Heart failure; Left ventricular filling pressures; Left ventricular mass