title: Long-term outcome of patients with triphasic mitral flow with a mid-diastolic L wave: prognostic role of left atrial volume and N-terminal pro-brain natriuretic peptide.
abstract: A mid-diastolic L wave has been recognized as a marker of advanced left ventricular (LV) diastolic dysfunction. However, its prognostic implication is unclear. This study assessed long-term prognosis and independent predictors of adverse outcomes in patients with a mid-diastolic L wave. A total of 144 consecutive patients (mean age 63 ± 12 years, 88 female) with a mid-diastolic L wave of ≥0.2 m/s and in sinus rhythm were identified. Patients with significant valvular heart disease, low LV ejection fraction and arrhythmias were excluded. Subjects were followed up for cardiovascular (CV) mortality and hospitalization for heart failure (HF). During follow-up for a median of 44 months (1-76), CV deaths and hospitalization for HF occurred in 41 (28%) patients. In multivariate Cox analysis, age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.02-1.11; p = 0.001), log N-terminal pro-brain natriuretic peptide (NT-proBNP)(HR 3.81; 95% CI 1.78-8.15; p = 0.001), and left atrial volume index (HR 1.02; 95% CI 1.01-1.04; p = 0.019) were independent predictors of adverse outcomes in patients with a mid-diastolic L wave. In a stepwise model, NT-proBNP showed an incremental prognostic value for prediction of adverse outcomes when added to the clinical and echocardiographic parameters (Chi square from 30.1 to 41.1, p < 0.001). Patients with a mid-diastolic L wave and clinical, biochemical, and echocardiographic evidence of advanced diastolic dysfunction showed poor long-term clinical outcome.
authors.affiliation: Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors.forename: Sung-Ai
authors.initials: SA
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
authors.forename: Jungwoo
authors.initials: J
authors.lastname: Son
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Institute, Yonsei University College of Medicine, Seodaemun-GuShinchon-Dong 134, Seoul, 120-752, South Korea.
authors.forename: Chi-Young
authors.initials: CY
authors.lastname: Shim
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Institute, Yonsei University College of Medicine, Seodaemun-GuShinchon-Dong 134, Seoul, 120-752, South Korea.
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Institute, Yonsei University College of Medicine, Seodaemun-GuShinchon-Dong 134, Seoul, 120-752, South Korea. jwha@yuhs.ac.
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
mesh_terms: D000368:Aged; D016279:Atrial Function, Left; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Brain natriuretic peptides; Diastolic dysfunction; Echocardiography