ASE: Diastolic Dysfunction Predicts MI or Coronary Disease Readmission

SEATTLE, June 25 -- Severe diastolic dysfunction tops all other echocardiograhic measures as a post-MI prognostic marker, researchers reported here.
The finding came from a prospective evaluation of 199 patients with a history of coronary artery disease (N=36), ST-segment elevation MI (N=118), or heart failure (N=8), according to Taiyeb Khumri, M.D., of the Mid-America Heart Institute in Kansas City.
All had complete echocardiographic assessments at index admission, he and colleagues said at the American Society of Echocardiography meeting.
In the first year after the index admission, more than three fourths of patients with severe diastolic dysfunction were readmitted for cardiovascular reasons. Evaluation of all patients readmitted during the first year showed that severe dysfunction was the only echocardiographic predictor of readmission.
Reviewing the background of the study, Dr. Khumri noted that diastolic dysfunction is a common finding after acute MI, and left-ventricular diastolic dysfunction predicts in-hospital heart failure, subsequent left-ventricular remodeling, and long-term mortality.
Although Doppler echo is useful for assessing left-ventricular diastolic function, echo-related factors associated with the risk of readmission had not been examined carefully.
Echocardiographic exams of the 199 patients showed that 18 had severely abnormal diastolic function. During the 12 months after infarction, 78% were rehospitalized. Overall, 82 of the 199 patients were rehospitalized for cardiovascular reasons within a year of their index admission.
The Kansas City investigators performed a multivariate analysis on more than 20 variables that could influence the risk of rehospitalization at 12 months. The only factors that proved to be significant predictors were education (P=0.02), peripheral arterial disease (P=0.007), previous angina (P=0.028), and severe diastolic dysfunction (P=0.018).
A total of 74 patients had a left-ventricular ejection fraction of less than 40% at the index admission. The multivariate analysis initially suggested that ejection fraction significantly influenced the risk of rehospitalization (P=0.035), but statistical confidence intervals associated with that P-value crossed the 1.0 threshold.

VALIDD: Lowering Blood Pressure Improves Diastolic Dysfunction

Sue Hughes
Heartwire 2007. © 2007 Medscape
March 26, 2007 (New Orleans, LA) - Lowering blood pressure can improve diastolic dysfunction even in patients with mild hypertension, a new study has shown.
The Valsartan in Diastolic Dysfunction (VALIDD) trial, presented today at the American College of Cardiology 2007 Scientific Sessions, is the first large-scale randomized trial to assess a therapeutic intervention for improvement of diastolic function using new noninvasive Doppler technology. The study’s primary objective was to compare the effect on diastolic dysfunction of two antihypertensive regimens--one based on an inhibitor of the renin angiotensin system (RAS) and one based on other medications--in patients with mild hypertension. While there was no difference between these two groups, both groups showed a substantial reduction in blood pressure that was itself associated with a significant improvement in diastolic dysfunction.
Lead investigator Dr Scott Solomon (Brigham and Women’s Hospital, Boston, MA) said: “Our study has shown an important result. Diastolic dysfunction is an important pathophysiology between hypertension and heart failure, affecting around half of hypertension patients. Patients with diastolic dysfunction have an increased risk of developing heart failure, but there is no targeted therapy for this condition. This study suggests that lowering blood pressure is the most important thing we can do for patients with hypertension and diastolic dysfunction and shows that we need to be more aggressive in this regard even in patients with only mildly elevated blood pressure."