Diastolic Dysfunction and Survival in Patients With Preserved or Mildly Reduced Left Ventricular Ejection Fraction Following Myocardial Infarction

Background: Left ventricular ejection fraction (LVEF) is relatively indiscriminate for prognosis in patients with preserved or mildly reduced LVEF (>40%) following myocardial infarction (MI). This study sought to determine the value of guideline-based assessment of diastolic dysfunction (DD) in predicting long-term all-cause and cardiac mortality in patients with a first-ever MI and LVEF >40%. Methods: A retrospective single-center study involving 2,234 patients with a first-ever MI (ST elevation MI or non-ST elevation MI) with LVEF >40% was performed. Clinical, angiographic, echocardiographic, and outcomes data were obtained from prospectively maintained institutional and statewide databases. Echocardiography was performed early postadmission for all patients. Significant DD was defined was grade 2 and 3 DD. Results: The mean age of patients was 61.4 +/- 12.3 years, 70.7% were male, and 12.1% had 3-vessel disease. The mean LVEF was 55.8% +/- 7.2%, and 14.1% had significant DD. At a median follow-up of 4.5 years, there were 219 deaths (46 cardiac deaths). On Cox proportional hazards multivariable analyses incorporating significant clinical, angiographic, and echocardiographic variables, significant DD was an independent predictor of both all-cause (hazard ratio = 2.01; 95% CI, 1.37-2.94; P < .001) and cardiac (hazard ratio = 3.97; 95% CI, 1.98-7.99; P < .001) mortality. Bootstrapping and calculation of Harrel's C confirmed the independent association of significant DD with outcomes. Conclusions: Significant DD is an independent predictor of all-cause and cardiac mortality following MI in patients with preserved or mildly reduced LVEF and thus effectively reclassifies prognosis in a subgroup where the LVEF is relatively indiscriminate for survival. The benefit of further investigation and/or treatment in this subgroup needs further study.