Diastolic Function Grading by American Society of Echocardiography Guidelines and Prediction of Heart Failure Readmission and All-Cause Mortality in a Community-Based Cohort

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Background: Diastolic function (DF) guidelines have been simplified but lack extensive outcome data. Using a rural university heart failure (HF) database, we assessed whether DF grading could predict HF, HF readmission, and all-cause mortality (ACM). Methods: In this single-center retrospective study that included 613 patients in sinus rhythm hospitalized for HF (HF with preserved—254 patients, with mid-range—216 patients, and reduced ejection fraction—143 patients), we recorded demographics, Doppler-echo, Framingham HF score, laboratories, HF readmission, and ACM with follow-up to 2167 days. Results: Diastolic dysfunction (Ddys) parameters (left atrial volume index [LAVI] > 34 ml/m2, tricuspid regurgitation [TR] velocity > 2.8 m/sec, and E/e’ > 14) had moderate sensitivity (46.2%–65.0%) for predicting HF among all phenotypes combined with DF grading having moderate predictability and additive to a clinical composite for HF prediction (AUC =.677, P < 0.0001; difference =.043, P < 0.001) for combined phenotypes. Ddys parameters and Ddys severity (2016 ASE criteria: grade II and III) were significantly associated with HF readmission for decompensated HF within 60–2167 days of follow-up (LAVI > 34 ml/m2: HR 1.56 [1.26–2.19]; E/e’ > 14: HR 1.44 [1.21–1.99]; TR > 2.8 m/sec: H1.43 [1.19–1.88]; LV Dys grade II: HR 2.12 [1.42–2.96]; LV Ddys grade III: HR 2.39 [1.57–4.82]). Conclusion: The findings of this study highlight the clinical and prognostic relevance of determining the severity of LV Ddys in patients with HF with regard to HF verification and HF readmission.