Background: Diastolic dysfunction (DD) is highly prevalent and associated with increased morbidity and mortality, but its natural history remains poorly defined.
Objective: This cohort study sought to characterize the influence of clinical features, medical therapy and echocardiographic parameters on the progression of DD.
Methods: We identified 926 consecutive patients (62 ± 14 years, 221 women) with DD and preserved systolic function. A repeat echocardiogram was performed in 199 patients >1 year after the baseline study (average 3.6±1.4 years). Follow-up for 4.8±2.5 years was 97% complete for the major endpoint of all-cause mortality. Cox regression analyses were performed to identify the associations of mortality.
Results: Over follow-up, 142 patients died and 22 were admitted with heart failure. The independent predictors of death were age, hyperlipidaemia, co-morbid disease and restrictive filling. The degree of diastolic dysfunction remained stable in 52%, deteriorated in 27% and improved in 21%. There was a greater use of medical therapy in those with stable or worsening diastolic function; when the protective effects of these agents were taken into account in a multivariate model, improvement in diastolic dysfunction was associated with a survival benefit.
Conclusion: DD is associated with all-cause mortality, independent of the presence of a major co-morbidity. The degree of DD remains stable in about 50% of patients, the population whose diastolic function improves over time has a more favourable outcome.
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