Open AccessPrognostic impact of diastolic dysfunction in systolic heart failure—A cross‐project analysis from the German Competence Network Heart Failure
Author(s) -
Lüers Claus,
Edelmann Frank,
Wachter Rolf,
Pieske Burkert,
Mende Meinhard,
Angermann Christiane,
Ertl Georg,
Düngen HansDirk,
Störk Stefan
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22710
Subject(s) - medicine , heart failure , diastole , competence (human resources) , cardiology , german , diastolic heart failure , blood pressure , management , archaeology , economics , history
Background We investigated the modifying role and prognostic importance of diastolic dysfunction ( DD ) in patients with heart failure and systolic dysfunction ( SD ). Hypothesis The echocardiographic evaluation of diastolic function in patients with SD provides further prognostic information. Methods From the German Competence Network Heart Failure, 1046 heart failure patients with reduced left ventricular ejection fraction ( LVEF ; <50%) were echocardiographically studied and followed for a median of 5 years. SD was subdivided into nonsevere ( LVEF 36%–49%) and severe ( LVEF ≤35%); DD was subdivided into nonsevere (E/E′ <15) and severe (E/E′ ≥15). Results In general, severe SD was associated with higher hazard ratios ( HRs ; 2‐fold to 3.5‐fold) for all endpoints (all‐cause death, cardiac death, cardiovascular hospitalization, duration of hospitalization). Patients with severe SD had a 2.5‐fold risk of death (95% confidence interval [ CI ]: 1.84‐3.47, P < 0.001), and patients with severe DD showed a 1.8‐fold risk (95% CI : 1.17‐2.61, P = 0.004). Furthermore, we observed a strong interaction of SD and DD : concomitant severe DD in patients with moderate SD increased risk substantially ( HR : 1.73, 95% CI : 1.16‐2.6, P = 0.007); by contrast, in patients with severe SD , additional presence of severe DD added little or no risk ( HR for interaction: 0.5–1.2). Conclusions In heart failure patients with reduced LVEF , the evaluation of diastolic function provides additional prognostic information. Although severe SD generally increased the risk for all endpoints, the degree of DD and its impact as a prognostic marker for overall and cardiovascular mortality appeared of particular relevance in subjects with nonsevere SD .