Clinical InvestigationImaging and Diagnostic TestingA comparison of echocardiographic measures of diastolic function for predicting all-cause mortality in a predominantly male population

BackgroundPrior studies demonstrating the prognostic value of echocardiographic measures of diastolic function have been limited by sample size, have included only select clinical populations, and have not incorporated newer measures of diastolic function nor determined their independent prognostic value. The objective of this study is to determine the independent prognostic value of established and new echocardiographic parameters of diastolic function.MethodsWe included 3,604 consecutive patients referred to 1 of 3 echocardiography laboratories over a 2-year period. We obtained measurements of mitral inflow velocities, pulmonary vein filling pattern, mitral annulus motion (e′), and propagation velocity (Vp). The primary end point was 1-year all-cause mortality.ResultsThe mean age of the patients was 68 years, and 95% were male. There were 277 deaths during a mean follow-up of 248 ± 221 days. For patients with reduced left ventricular ejection fraction (LVEF), all measured parameters except for e′ were associated with mortality (P < .05) on univariate analysis. For patients with preserved LVEF, the E-wave velocity was significantly associated with mortality (P < .05) on univariate analysis. The deceleration time/E-wave velocity ratio, Vp, and pulmonary vein filling pattern were borderline significant (P < .10). With multivariate analysis, only Vp was associated with survival for both reduced (P = .02) and preserved LVEF groups (P = .01).ConclusionIn a large, clinically diverse population, most measures of diastolic function were predictive of all-cause mortality without adjustment for patient characteristics. On multivariate analysis, only Vp was independently associated with total mortality. This association with mortality may be related to factors other than diastolic function and warrants further investigation.