Diastolic function grading by American Society of Echocardiography guidelines and prediction of heart failure readmission and all‐cause mortality in a community‐based cohort

Abstract

Background Diastolic function (DF) guidelines have been simplified but lack extensive outcome data. Using a rural university heart failure (HF) database, we assessed whether DF grading could predict HF, HF readmission, and all‐cause mortality (ACM). Methods In this single‐center retrospective study that included 613 patients in sinus rhythm hospitalized for HF (HF with preserved—254 patients, with mid‐range—216 patients, and reduced ejection fraction—143 patients), we recorded demographics, Doppler‐echo, Framingham HF score, laboratories, HF readmission, and ACM with follow‐up to 2167 days. Results Diastolic dysfunction (Ddys) parameters (left atrial volume index [LAVI] > 34 ml/m2, tricuspid regurgitation [TR] velocity > 2.8 m/sec, and E/e’ > 14) had moderate sensitivity (46.2%–65.0%) for predicting HF among all phenotypes combined with DF grading having moderate predictability and additive to a clinical composite for HF prediction (AUC = .677, P < 0.0001; difference = .043, P < 0.001) for combined phenotypes. Ddys parameters and Ddys severity (2016 ASE criteria: grade II and III) were significantly associated with HF readmission for decompensated HF within 60–2167 days of follow‐up (LAVI > 34 ml/m2: HR 1.56 [1.26–2.19]; E/e’ > 14: HR 1.44 [1.21–1.99]; TR > 2.8 m/sec: H1.43 [1.19–1.88]; LV Dys grade II: HR 2.12 [1.42–2.96]; LV Ddys grade III: HR 2.39 [1.57–4.82]). Conclusion The findings of this study highlight the clinical and prognostic relevance of determining the severity of LV Ddys in patients with HF with regard to HF verification and HF readmission.

Discriminative Utility of Apelin-to-NT-Pro-Brain Natriuretic Peptide Ratio for Heart Failure with Preserved Ejection Fraction among Type 2 Diabetes Mellitus Patients

“…In this study, we first found that the apelin to NT-proBNP ratio < 0.82 × 10 −2 units had independent from other biomarkers, such as LAVI, E/e', LV hypertrophy and hs-TrT, discriminant potency for HFpEF in T2DM patients' population. Although parameters that strongly describe the severity of LV diastolic dysfunction including LV hypertrophy, LAVI and E/e', have previously demonstrated their clinical and prognostic relevance of determining the HF occurrence, HF admission and all-cause mortality in general population [36][37][38][39], HFpEF continues to be misdiagnosed in T2DM patients [40]. In this context, biomarkers' models appear to be powerful multimodal diagnostic and predictive tools to identify T2DM patients with different degree of adverse cardiac remodeling and stratify them at the risk of HFpEF manifestation [41].…”

The Role of CCTA-derived Cardiac Structure and Function Analysis in the Prediction of Readmission in Nonischemic Heart Failure

“…Throughout the entire echocardiographic assessment, a single-lead electrocardiogram was recorded. Following the guidelines of the American Society of Echocardiography, a phased-array transducer with a fusion frequency of 2–4 MHz was employed [ 16 ]. Imaging was conducted in M-mode and 2D modes, capturing images in parasternal long-axis, short-axis, apical four-chamber, and two-chamber views and at the aortic root for evaluation.…”