BACKGROUND Left ventricular diastolic dysfunction (DD) and myocardial scar are important contributors to cardiovascular morbidity and mortality. The aim of this study was to test the hypothesis that myocardial scar is a substrate of DD and that collectively they contribute to increased risk for all-cause mortality. METHODS The study included 607 consecutive patients who underwent echocardiography and cardiac magnetic resonance imaging within 1 week. DD was assessed by echocardiography according to the contemporary guidelines and myocardial scar by late gadolinium enhancement (LGE). All-cause mortality was the main outcome. RESULTS Scar prevalence was significantly higher comparing no DD with mild and advanced DD (25%, 61%, and 80%, respectively; P < .001), and scar burden was greater by semiquantitative LGE scores (1.4 ± 3.4, 4.8 ± 6.3, and 6.8 ± 8.8, respectively; P < .001). After 10 years of follow-up, 50 patients (8.2%) had died. The mortality incidence was significantly higher comparing no DD with mild and advanced DD (2.5, 17.3, and 55.7 deaths per 1,000 person-years, respectively; P < .001). It was also higher in patients with higher LGE scores (4.3, 22.7, and 35.2 deaths per 1,000 person-years in groups with LGE scores of 0, 1-6, and ≥7, respectively; P < .001). The risk for death was higher among patients with both DD and scar. The additive interaction of DD and scar for mortality was significant (P < .001). In the multivariate Cox proportional-hazards analysis, DD and scar were associated with mortality (P < .001). CONCLUSIONS There is a strong link between the echocardiographic findings of DD and the morphologic changes of myocardial tissue. DD assessed according to contemporary guidelines effectively differentiates mortality risk. The additive interaction of DD and scar on mortality risk highlights the pivotal role of myocardial tissue characterization in patients with DD.

中文翻译：

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左心室舒张功能障碍与心肌瘢痕之间的关联及其对全因死亡率的集体影响。

背景技术左心室舒张功能障碍（DD）和心肌疤痕是心血管发病率和死亡率的重要因素。这项研究的目的是检验以下假设：心肌瘢痕是DD的底物，它们共同导致全因死亡的风险增加。方法该研究纳入了607例连续的患者，这些患者在1周内接受了超声心动图和心脏磁共振成像检查。DD通过超声心动图根据当代指南进行评估，心肌瘢痕通过晚期enhancement增强（LGE）进行评估。全因死亡率是主要结果。结果与无DD相比，轻度和晚期DD的疤痕患病率显着更高（分别为25％，61％和80％； P <.001），并且通过半定量LGE评分，疤痕负担更大（1.4±3.4、4.8±6.3）和6。分别为8±8.8；P <.001）。经过10年的随访，有50名患者（8.2％）死亡。与无DD和轻度和晚期DD相比，死亡率更高（分别为每1000人年2.5、17.3和55.7例死亡； P <.001）。LGE得分较高的患者的病死率也更高（LGE得分分别为0、1-6和≥7的组中每千人年有4.3、22.7和35.2例死亡； P <.001）。DD和疤痕患者的死亡风险更高。DD与疤痕的加性相互作用对死亡率具有显着意义（P <.001）。在多变量Cox比例风险分析中，DD和疤痕与死亡率相关（P <.001）。结论DD的超声心动图检查结果与心肌组织的形态学变化之间有很强的联系。根据当代指南评估的DD可有效区分死亡风险。DD和疤痕对死亡风险的累加相互作用突显了DD患者心肌组织表征的关键作用。