Granot Yoav, Ben-Assa Eyal, Sapir Orly, Laufer-Perl Michal, Topilsky Yan, Rozenbaum Zach
Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA.
Int J Cardiol. 2021 Jun 1;332:216-222. doi: 10.1016/j.ijcard.2021.03.054. Epub 2021 Mar 26.
The conveyed risk of mild diastolic dysfunction (MDD) according to age had not been thoroughly studied. We aimed to investigate the mortality-risk of MDD by age-groups among inpatients with preserved ejection fraction (EF), and determine ranges of diastolic function parameters by prognosis.
In a single-center retrospective study we identified inpatients who underwent echocardiography between 2012 and 2018 and had preserved EF without significant valvulopathies. Propensity scores were used to adjust for baseline characteristics and main diagnoses at discharge. Comparisons for all-cause mortality between MDD and normal diastolic function were conducted by age groups. Using classification and regression trees (CART) modeling we determined age-specific cut-offs according to outcome.
The cohort consisted of 15,777 inpatients. Mortality rate during a 33.9-months median follow-up was 21.6%. MDD was associated with increased mortality risk among all ages up to 90 years, thereafter no difference was detected. Adjusted hazard ratios inversely related to age - 1.99(95%CI 1.25-3.16, p = 0.004), 1.82(95%CI1.46-2.26, p < 0.001), 1.88(95%CI1.64-2.15, p < 0.001), 1.78(95%CI1.59-2.01, p < 0.001), and 1.32(95%CI0.95-1.83, p = 0.093), for 18-44, 45-59, 60-74, 75-89, and ≥90 years, respectively (Pinteraction = 0.009). New cut-offs of E/e' for ages 75-89(16), e' lateral for ages ≥90(6 cm/s), e' septal for ages 60-74(5 cm/s), and E/A ratio for ages 18-44(1.5), predicted outcome more accurately than guidelines-based recommendations. The remaining cut-offs were not better predictors compared to guidelines-based recommendations.
MDD is a consequential finding at all ages up to 90 years among inpatients with preserved EF, although its significance decreases with age. Diastolic function of several age-groups may be better delineated by cut-offs that presage adverse prognoses. Helsinki committee approval number: 0170-17-TLV.
根据年龄所传达的轻度舒张功能障碍（MDD）风险尚未得到充分研究。我们旨在调查射血分数（EF）保留的住院患者中按年龄分组的MDD死亡风险，并根据预后确定舒张功能参数范围。
在一项单中心回顾性研究中，我们确定了2012年至2018年间接受超声心动图检查且EF保留且无明显瓣膜病变的住院患者。倾向评分用于调整出院时的基线特征和主要诊断。按年龄组对MDD和正常舒张功能之间的全因死亡率进行比较。使用分类和回归树（CART）模型，我们根据结果确定了特定年龄的临界值。
该队列包括15777名住院患者。在33.9个月的中位随访期间，死亡率为21.6%。在90岁及以下的所有年龄段中，MDD与死亡风险增加相关，此后未检测到差异。调整后的风险比与年龄呈负相关——18 - 44岁为1.99（95%CI 1.25 - 3.16，p = 0.004），45 - 59岁为1.82（95%CI 1.46 - 2.26，p < 0.001），60 - 74岁为1.88（95%CI 1.64 - 2.15，p < 0.001），75 - 89岁为1.78（95%CI 1.59 - 2.01，p < 0.001），≥90岁为1.32（95%CI 0.95 - 1.83，p = 0.093）（P交互作用 = 0.009）。75 - 89岁的E/e'新临界值为16，≥90岁的e'外侧为6 cm/s，60 - 74岁的e'间隔为5 cm/s，18 - 44岁的E/A比值为1.5，与基于指南的建议相比，能更准确地预测结果。与基于指南的建议相比，其余临界值并非更好的预测指标。
在EF保留的住院患者中，90岁及以下的所有年龄段中MDD都是一个重要发现，尽管其重要性随年龄降低。几个年龄组的舒张功能可以通过预示不良预后的临界值更好地界定。赫尔辛基委员会批准编号：0170 - 17 - TLV。
