1. Prognostic Impact of Diastolic Wall Strain in Patients at Risk for Heart Failure
- Author
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Uichi Ikeda, Koji Yoshie, Wataru Shoin, Yasushi Ueki, Hitoshi Nishimura, Naoto Hashizume, Kunihiko Shimizu, Naoyuki Abe, Mikiko Harada, Soichiro Ebisawa, Yasutaka Oguchi, Takashi Miura, Hirohiko Motoki, Masatoshi Minamisawa, Atsushi Izawa, Tomoaki Mochidome, and Jun Koyama
- Subjects
medicine.medical_specialty ,Diastole ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,Retrospective Studies ,Heart Failure ,Ejection fraction ,business.industry ,Proportional hazards model ,Hazard ratio ,General Medicine ,Prognosis ,medicine.disease ,humanities ,Confidence interval ,Echocardiography ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Diastolic wall strain (DWS) is based on the linear elastic theory, according to which decreased wall thinning during diastole reflects reduced left ventricular compliance and thus increased diastolic stiffness. Increased diastolic stiffness as assessed by DWS is associated with a worse prognosis in patients who have heart failure (HF) with preserved ejection fraction. However, there are no data about the prognostic value of DWS derived by M-mode echocardiography in patients at risk for HF. We retrospectively enrolled 1829 consecutive patients without prior HF who were hospitalized for cardiovascular (CV) diseases in our hospital between 2005 and 2012. Patients were divided into two groups stratified by DWS (median value 0.34). The study endpoint was the composite of major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke, and hospitalization for HF. Over a 4.2-year median follow-up, adverse events were observed in 322 patients (17.6%). In Kaplan-Meier analysis, patients with low DWS (≤ 0.34, n = 915) showed worse prognoses than those with high DWS (> 0.34, n = 914) (MACE incidence 39.4% versus 31.9%, P = 0.011). In multivariate Cox proportional hazards analysis after the adjustment for age, sex, and echocardiographic parameters, low DWS (≤ 0.34) was significantly associated with the incidence of MACE (hazard ratio: 1.26, 95% confidence interval: 1.01-1.59; P = 0 .045). In patients without prior HF, DWS is an independent predictor of MACE. Simple assessment of DWS might improve risk stratification for CV events in those patients.
- Published
- 2017