Validation and Comparison of the 2003 and 2016 Diastolic Functional Assessments for Cardiovascular Mortality in a Large Single-Center Cohort.

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.