CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

June 28th, 2011

Diastolic Dysfunction Linked to Mortality

A new study sheds light on the prognostic value of diastolic dysfunction (DD) in patients with normal systolic function. In a study published in the Archives of Internal Medicine, Carmel Halley and colleagues reviewed echocardiograms from 36,261 consecutive patients who were found to have normal systolic function. Nearly two thirds (65.2%) had some degree of DD.

There were 5789 deaths during 6.2 years of follow-up. The greater the degree of diastolic dysfunction, the higher the mortality rate:

  • normal diastolic function: 7% mortality
  • mild DD: 21% mortality
  • moderate DD: 24% mortality
  • severe DD: 39% mortality

In a separate analysis using propensity matching, only moderate and severe DD were significantly associated with mortality.

In an invited commentary, Ileana Piña writes that the study provides important new information about DD, informing physicians that DD is common and that physicians should “be aware of the prognostic value of moderate and severe DD.” But the study does not appear to shed light on the large group of elderly women who present with acute heart failure, she writes.

Categories: Heart Failure
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5 Responses to “Diastolic Dysfunction Linked to Mortality”

  1. Xavier Prida, MD says:
    June 30, 2011 at 7:19 pm

    And, what pray tell, are strategies to modify the prognosis(I’m not referring to relief of symptoms)?

  2. William DeMedio, MD says:
    July 1, 2011 at 12:17 am

    I’m not surprised by the results of the study, now a remedy needs to be found which lowers the mortality.

    Competing interests pertaining specifically to this post, comment, or both:
    none

  3. Harlan M. Krumholz, MD, SM says:
    July 4, 2011 at 4:15 pm

    What was not clear to me in this paper was how the information from the diastolic indices added to the clinical impression of the prognosis. It seemed to me that the authors had limited information about the clinical status of the patient at the time of the study and that information might have attenuated some of the prognostic importance that they report. I feel we need more and better studies that help us understand the degree to which this information improves in a meaningful way our classification of risk.

  4. David Powell , MD, FACC says:
    July 7, 2011 at 7:53 pm

    The authors did the best they could with propensity matching in this retrospective study. A major issue is grading of diastolic function, which varied in the study. Criteria are imprecise. I am not sure whether LA volume was part of their diastolic grading system (as officially recommended now by ASE). If not, I would have liked to see the prognostic power of this measurement alone.

  5. Sidney Daffin, B.S,M.D. says:
    July 8, 2011 at 5:08 pm

    I use impedence cardiography in conjunction with echo to further evaluate patients with diastolic dysfunction.Changes in the ICG often preceed echo changes and are more quantifiable.I would like to know if a comparative study between echo and ICG has been done in pure diastolic dysfunction.

    Competing interests pertaining specifically to this post, comment, or both:
    none