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Validation and Comparison of the 2003 and 2016 Diastolic Functional Assessments for Cardiovascular Mortality in a Large Single-Center Cohort.
Journal of the American Society of Echocardiography ( IF 5.4 ) Pub Date : 2020-02-20 , DOI: 10.1016/j.echo.2019.11.013
Hsin-Yueh Liang , Yen-Chun Lo , Hsiu-Yin Chiang , Ming-Fong Chen , Chin-Chi Kuo

BACKGROUND The prognostic performance of the diastolic dysfunction (DD) algorithms published by the Mayo Clinic research group in 2003 and the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) in 2016 in association with cardiovascular (CV) mortality was compared in this study. METHODS A retrospective hospital cohort comprising 57,630 adults who had undergone comprehensive echocardiographic examinations between 2008 and 2016 was analyzed. All echocardiographic parameters were measured according to appropriate guidelines, and dates of CV death were verified using the national mortality database. The prognostic performance of the Mayo 2003 and ASE/EACVI 2016 algorithms in association with 3-year CV mortality was systematically investigated. RESULTS The adjusted hazard ratio (aHR) for severe DD defined by Mayo 2003 (1.64; 95% CI, 1.02-2.64; P = .04) was less than that defined by ASE/EACVI 2016 (aHR, 2.46; 95% CI, 1.58-3.84; P < .001) compared with patients with normal diastolic function. According to the ASE/EACVI 2016 algorithm, the cumulative 3-year CV mortality rate was 2.4% (95% CI, 1.8%-3.0%) for normal diastolic function, 4.7% (95% CI, 4.0%-5.4%) for mild DD, 5.8% (95% CI, 5.0%-6.7%) for moderate DD, 8.3% (95% CI, 6.1%-10.5%) for severe DD, and 3.8% (95% CI, 2.8%-4.8%) for indeterminate DD, respectively (P < .001). The dose-mortality patterns following DD severity were observed only in the ASE/EAVCI 2016 classification. The risk for 3-year CV mortality in patients with concomitant left ventricular ejection fraction < 40% and severe DD was 7 times (aHR, 7.81 [95% CI, 3.81-16.0; P < .05] for Mayo 2003; aHR, 7.67 [95% CI, 4.61-12.8; P < .05] for ASE/EACVI 2016) higher than that in patients with left ventricular ejection fractions ≥ 60% and normal diastolic function. The absolute number of patients who were correctly reclassified by ASE/EAVCI 2016 was 23,181, corresponding to 42% of the absolute net reclassification index. CONCLUSIONS DD and impaired left ventricular ejection fraction increased CV mortality risk in a mutually independent manner. The severity of DD on the basis of ASE/EACVI 2016 has a graded relationship with CV mortality in a large population cohort.

中文翻译:

在大型单中心队列中验证和比较 2003 年和 2016 年心血管死亡率的舒张功能评估。

背景 Mayo Clinic 研究小组 2003 年和美国超声心动图学会 (ASE) 和欧洲心血管影像学协会 (EACVI) 于 2016 年发布的舒张功能障碍 (DD) 算法与心血管 (CV) 死亡率相关的预后性能在本研究中进行了比较。方法 对 2008 年至 2016 年间接受全面超声心动图检查的 57,630 名成年人组成的回顾性医院队列进行了分析。根据适当的指南测量所有超声心动图参数,并使用国家死亡率数据库验证 CV 死亡日期。系统研究了 Mayo 2003 和 ASE/EACVI 2016 算法与 3 年 CV 死亡率相关的预后性能。结果 Mayo 2003 定义的严重 DD 的调整风险比 (aHR) (1.64; 95% CI, 1.02-2.64; P = .04) 低于 ASE/EACVI 2016 (aHR, 2.46; 95% CI, 1.58-3.84;P < .001)与舒张功能正常的患者相比。根据 ASE/EACVI 2016 算法,正常舒张功能的累积 3 年 CV 死亡率为 2.4%(95% CI,1.8%-3.0%),正常舒张功能为 4.7%(95% CI,4.0%-5.4%)轻度 DD,中度 DD 为 5.8%(95% CI,5.0%-6.7%),重度 DD 为 8.3%(95% CI,6.1%-10.5%),3.8%(95% CI,2.8%-4.8%) ) 分别表示不确定的 DD (P < .001)。仅在 ASE/EAVCI 2016 分类中观察到 DD 严重程度后的剂量-死亡率模式。伴随左心室射血分数 < 40% 和严重 DD 的患者 3 年心血管死亡风险是 7 倍(aHR,7.81 [95% CI,3. 81-16.0;P < .05] 对于 Mayo 2003;aHR,7.67 [95% CI,4.61-12.8;P < .05] for ASE/EACVI 2016) 高于左心室射血分数 ≥ 60% 和正常舒张功能的患者。ASE/EAVCI 2016 正确重新分类的患者绝对数为 23,181,相当于绝对净重新分类指数的 42%。结论 DD 和左心室射血分数受损以相互独立的方式增加 CV 死亡风险。在 ASE/EACVI 2016 的基础上,DD 的严重程度与大型人群队列中的 CV 死亡率存在分级关系。ASE/EAVCI 2016 正确重新分类的患者绝对数为 23,181,相当于绝对净重新分类指数的 42%。结论 DD 和左心室射血分数受损以相互独立的方式增加 CV 死亡风险。在 ASE/EACVI 2016 的基础上,DD 的严重程度与大型人群队列中的 CV 死亡率存在分级关系。ASE/EAVCI 2016 正确重新分类的患者绝对数为 23,181,相当于绝对净重新分类指数的 42%。结论 DD 和左心室射血分数受损以相互独立的方式增加 CV 死亡风险。在 ASE/EACVI 2016 的基础上,DD 的严重程度与大型人群队列中的 CV 死亡率存在分级关系。
更新日期:2020-02-20
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