Background

Recent American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines for the assessment of diastolic dysfunction (DD) recommend a simplified approach with four key variables incorporated into a novel diagnostic algorithm. The aim of this study was to assess the prognostic value of significant DD assessed using the algorithm recommended in the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines (DD2016) in comparison with the prognostic value of significant DD assessed using the 2009 guidelines (DD2009) as well as the individual parameters incorporated in the 2016 algorithm.

Methods

Retrospective data on 419 consecutive patients with first ever myocardial infarction were included. Doppler echocardiography was performed within 24 hours of admission in all patients. Significant DD was defined as grade 2 or 3 DD. The primary outcome measure was composite major adverse cardiovascular events (MACEs), comprising death, myocardial infarction, and heart failure.

Results

At a median follow-up of 24 months, there were 61 MACEs. On Kaplan-Meier analysis, DD2016 showed a better association with MACEs than DD2009 (log-rank χ² = 21.01 [P < .001] vs 13.13 [P = .001]). On Cox proportional-hazards multivariate analysis incorporating significant clinical predictors and left ventricular ejection fraction, DD2016 (hazard ratio, 2.22; 95% CI, 1.25–3.98; P = .007) was the strongest independent predictor of MACEs, whereas DD2009 (hazard ratio, 1.63; 95% CI, 0.95–2.80; P = .074) was not a significant predictor. Of the four key diastolic parameters, only left atrial volume index was independently associated with MACEs (hazard ratio, 1.79; 95% CI, 1.02–3.14; P = .041) when included in a Cox proportional-hazards multivariate model incorporating significant clinical predictors and left ventricular ejection fraction, although the association was weaker than DD2016. Intermodel comparisons with model χ² and Harrell's C statistic were satisfactory for DD2016.

Conclusions

Significant DD assessed using the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines is a robust independent predictor of clinical outcomes following myocardial infarction and compares favorably with DD2009 as well as the individual parameters incorporated in the novel 2016 algorithm.

中文翻译：

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使用当代指南评估心肌舒张功能障碍和心肌梗死后的预后

背景

最新的美国超声心动图学会和欧洲心血管影像协会评估舒张功能障碍（DD）的指南提出了一种简化方法，其中将四个关键变量纳入了一种新颖的诊断算法。这项研究的目的是评估使用2016年美国超声心动图学会和欧洲心血管成像协会指南（DD2016）推荐的算法评估的显着DD的预后价值，以及使用2009年指南评估的显着DD的预后价值（DD2009）以及2016年算法中包含的各个参数。

方法

回顾性研究了419例首次有心肌梗塞的患者。所有患者入院后24小时内进行多普勒超声心动图检查。重大DD被定义为2级或3级DD。主要结局指标是主要的严重不良心血管事件（MACE），包括死亡，心肌梗塞和心力衰竭。

结果

在24个月的中位随访中，有61例MACE。上Kaplan-Meier分析，DD2016显示出与锤比DD2009更好的关联（对数秩χ ²  = 21.01 [ P  <0.001]对13.13 [ P  = 0.001]）。在Cox比例风险多元分析中，结合重要的临床预测指标和左心室射血分数，DD2016（风险比，2.22； 95％CI，1.25–3.98；P  = .007）是MACE的最强独立预测因子，而DD2009（风险比） ，1.63； 95％CI，0.95-2.80；P  = .074）不是重要的预测指标。在四个关键的舒张期参数中，只有左心房容积指数与MACE独立相关（危险比，1.79； 95％CI，1.02-3.14；P = .041），但纳入Cox比例风险多变量模型时，尽管该关联性比DD2016弱，但该模型纳入了重要的临床预测指标和左心室射血分数。与模型χ交互型比较²和哈勒尔的C统计满意为DD2016。

结论

使用2016年美国超声心动图学会和欧洲心血管影像协会指南评估的重要DD是心肌梗死后临床结局的可靠独立预测因子，与DD2009以及纳入新的2016算法的各个参数相比具有优势。