Author + information
- Received March 12, 2014
- Revision received May 5, 2014
- Accepted May 12, 2014
- Published online August 1, 2014.
- Hiroshi Kuwaki, MD,
- Masaaki Takeuchi, MD∗ (, )
- Victor Chien-Chia Wu, MD,
- Kyoko Otani, MD,
- Yasufumi Nagata, MD,
- Atsushi Hayashi, MD,
- Mai Iwataki, MD,
- Shota Fukuda, MD,
- Hidetoshi Yoshitani, MD,
- Haruhiko Abe, MD and
- Yutaka Otsuji, MD
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
- ↵∗Reprint requests and correspondence:
Dr. Masaaki Takeuchi, Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
Objectives This study sought to examine left atrial (LA) mechanics and the prognostic impact of patients with echocardiographic findings of E/A ratio ≤0.75, deceleration time (DcT) of mitral E-wave >140 ms, but E/ε′ ≥10.
Background Traditional diastolic dysfunction (DD) grading system could not classify every patient into a specific group. We considered the group of patients with E/A ≤0.75, DcT >140 ms, but E/ε′ ≥10 (proposed new DD grade) as a new group in the DD grading system.
Methods A total of 1,362 consecutive patients were stratified according to the new DD grading system, and the LA volumes, strain, and strain rates were measured by 2-dimensional speckle-tracking analysis. All patients were followed up to determine cardiac death and major adverse cardiac events.
Results An E/A ≤0.75, DcT >140 ms, but E/ε′ ≥10 was observed in 227 patients (17%). LA volumes in patients with the new DD grade were between those of the impaired relaxation group and the pseudonormal group. LA strain of the new DD grade was similar to that of the pseudonormal group, whereas LA booster function was preserved as in the impaired relaxation group. During a mean follow-up of 3.0 ± 1.1 years, 25 patients had cardiac death and 61 had major adverse cardiac events. Event-free survival for major adverse cardiac events of the new DD grade was worse than that of the impaired relaxation group but similar to that of the pseudonormal group.
Conclusions The new DD grade is frequently observed and has a prognosis similar to that of the pseudonormal group but significantly worse than that of the impaired relaxation group. However, LA booster function was maintained at the expense of LA volume enlargement. Thus, the new grade should be a distinct entity for routine DD grading.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 12, 2014.
- Revision received May 5, 2014.
- Accepted May 12, 2014.
- American College of Cardiology Foundation