Effect of cardiac systolic and diastolic dysfunction on the prognosis of patients with coronary artery disease_West China Medical Journal

Authors：

XIN Zhemei ¹ , HUANG Baotao ¹ , HUANG Fangyang ¹ , ZHAO Zhengang ¹ , PENG Yong ¹ , HENG Yue ² , LIU Wei ¹ , LIAO Yanbiao ¹ , HUANG DeJia ¹ ,  CHEN Mao ¹

1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of General Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Mao, Email: hmaochen@vip.sina.com

Keywords：

Coronary artery disease; Systolic and diastolic dysfunction; Prognosis

DOI：

10.7507/1002-0179.201606056

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Objective To explore the role of systolic and diastolic dysfunction in the prognosis of Chinese patients with coronary artery disease (CAD). Methods CAD patients who underwent coronary arteriography in the Department of Cardiology of West China Hospital between July 2008 and June 2012 were included in this study. All the patients underwent color Doppler echocardiographic examination. Based on patients’ systolic and diastolic cardiac function, left ventricular ejection fraction (LVEF) <55% was as the systolic dysfunction and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e’) >15 was as the diastolic dysfuntion. They were divided into normal cardiac function group (LVEF≥55%, E/e’ ratio≤15), systolic and diastolic dysfunction group (LVEF<55%, E/e’ ratio>15), diastolic dysfunction group (LVEF≥55%, E/e’ ratio>15) and systolic dysfunction group (LVEF<55%, E/e’ ratio≤15). The end points of follow-up were all-cause death and a major cardiovascular event (MACE). Results A total of 985 patients with complete echocardiographic report were included in this study. During the follow-up of (21.4±9.7) months, 46 patients (4.7%) died, and 52 (5.4%) had a MACE. Systolic dysfunction concomitant with diastolic dysfunction group and systolic dysfunction group patients had a higher risk of 36-month all-cause death (4.8%, 10.7%,P<0.001) and a higher risk of 41-month MACE (8.6%, 7.6%,P=0.028). Single factor analysis of all-cause death mortality showed that compared with the normal group, all-cause death mortality was the highest in systolic and diastolic dysfunction group (P<0.05), followed by diastolic dysfunction group (P<0.05) and systolic dysfunction group (P>0.05). Single factor analysis of MACE showed that compared with the normal group, MACE was still the highest in systolic and diastolic dysfunction group (P<0.05), followed by systolic dysfunction group (P<0.05) and diastolic dysfunction group (P>0.05). A multivariate Cox regression model analysis showed that compared with the normal group, the risk of all-cause death was the highest in the systolic and diastolic dysfunction group [hazard ratio (HR)=2.96, 95% confidence interval (CI) (1.34, 6.54),P=0.007], followed by the systolic dysfunction group [HR=1.91, 95%CI (0.67, 5.42),P=0.224] and the diastolic dysfunction group [HR=0.95, 95%CI (0.40, 2.23),P=0.905]. Conclusion Compared with normal patients, patients with either systolic or diastolic dysfunction have a poorer prognosis, and patients with systolic dysfunction concomitant with diastolic dysfunction have the poorest prognosis.

Citation： XIN Zhemei, HUANG Baotao, HUANG Fangyang, ZHAO Zhengang, PENG Yong, HENG Yue, LIU Wei, LIAO Yanbiao, HUANG DeJia, CHEN Mao. Effect of cardiac systolic and diastolic dysfunction on the prognosis of patients with coronary artery disease. West China Medical Journal, 2017, 32(5): 705-711. doi: 10.7507/1002-0179.201606056 Copy

1.	Nozari Y, Oskouei NJ, Khazaeipour Z. Effect of elective percutaneous coronary intervention on left ventricular function in patients with coronary artery disease. Acta Med Iran, 2012, 50(1): 26-30.
2.	Ohara T, Little WC. Evolving focus on diastolic dysfunction in patients with coronary artery disease. Curr Opin Cardiol, 2010, 25(6): 613-621.
3.	Bonow RO, Mann DL, Zipes DP, et al. Braunwald’s heart disease: a textbook of cardiovascular medicine. 9th ed. Philadelphia: Elsevier Saunders, 2012.
4.	Hudzik B, Szkodzinski J, Romanowski W, et al. Serum interleukin-6 concentration reflects the extent of asymptomatic left ventricular dysfunction and predicts progression to heart failure in patients with stable coronary artery disease. Cytokine, 2011, 54(3): 266-271.
5.	Jons C, Joergensen RM, Hassager C, et al. Diastolic dysfunction predicts new-onset atrial fibrillation and cardiovascular events in patients with acute myocardial infarction and depressed left ventricular systolic function: a CARISMA substudy. Eur J Echocardiogr, 2010, 11(7): 602-607.
6.	Redfield MM, Jacobsen SJ, Burnett JC, et al. Burden of systolic and diastolic ventricular dysfunction in the community - appreciating the scope of the heart failure epidemic. JAMA, 2003, 289(2): 194-202.
7.	Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr, 2015, 28(1): 1-39.e14.
8.	Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr, 2005, 18(12): 1440-1463.
9.	Tsougos E, Paraskevaidis IA, Varounis C, et al. Long-term prognostic value of diastolic exercise echocardiography. Int J Cardiol. 2013, 169(1): e14-e16.
10.	Henkel DM, Malouf JF, Connolly HM, et al. Asymptomatic left ventricular systolic dysfunction in patients with severe aortic stenosis: characteristics and outcomes. J Am Coll Cardiol. 2012, 60(22): 2325-2329.
11.	Peteiro J, Bouzas-Mosquera A, Pazos P, et al. Prognostic value of exercise echocardiography in patients with left ventricular systolic dysfunction and known or suspected coronary artery disease. Am Heart J. 2010, 160(2): 301-307.
12.	Szadkowska I, Pawlicki L, Kowalski J, et al. Left ventricular dysfunction and NT-proBNP levels in patients with one-vessel disease after first ST-elevation myocardial infarction treated with primary coronary angioplasty. Kardiol Pol, 2009, 67(11): 1201-1206.
13.	Miszalski-Jamka T, Klimeczek P, Tomala M, et al. Extent of RV dysfunction and myocardial infarction assessed by CMR are independent outcome predictors early after STEMI treated with primary angioplasty. JACC Cardiovasc Imaging, 2010, 3(12): 1237-1246.
14.	Richardson-Lobbedez M, Maréchaux S, Bauters C, et al. Prognostic importance of tissue doppler-derived diastolic function in patients presenting with acute coronary syndrome: a bedside echocardiographic study. Eur J Echocardiogr. 2008, 9(5): 594-598.
15.	Khumri TM, Reid KJ, Kosiborod M, et al. Usefulness of left ventricular diastolic dysfunction as a predictor of one-year rehospitalization in survivors of acute myocardial infarction. Am J Cardiol. 2009, 103(1): 17-21.
16.	Bers DM. Calcium cycling and signaling in cardiac myocytes. Annu Rev Physiol, 2008, 70: 23-49.
17.	Bers DM. Altered cardiac myocyte Ca regulation in heart failure. Physiology (Bethesda). 2006, 21(6): 380-387.

1. Nozari Y, Oskouei NJ, Khazaeipour Z. Effect of elective percutaneous coronary intervention on left ventricular function in patients with coronary artery disease. Acta Med Iran, 2012, 50(1): 26-30.
2. Ohara T, Little WC. Evolving focus on diastolic dysfunction in patients with coronary artery disease. Curr Opin Cardiol, 2010, 25(6): 613-621.
3. Bonow RO, Mann DL, Zipes DP, et al. Braunwald’s heart disease: a textbook of cardiovascular medicine. 9th ed. Philadelphia: Elsevier Saunders, 2012.
4. Hudzik B, Szkodzinski J, Romanowski W, et al. Serum interleukin-6 concentration reflects the extent of asymptomatic left ventricular dysfunction and predicts progression to heart failure in patients with stable coronary artery disease. Cytokine, 2011, 54(3): 266-271.
5. Jons C, Joergensen RM, Hassager C, et al. Diastolic dysfunction predicts new-onset atrial fibrillation and cardiovascular events in patients with acute myocardial infarction and depressed left ventricular systolic function: a CARISMA substudy. Eur J Echocardiogr, 2010, 11(7): 602-607.
6. Redfield MM, Jacobsen SJ, Burnett JC, et al. Burden of systolic and diastolic ventricular dysfunction in the community - appreciating the scope of the heart failure epidemic. JAMA, 2003, 289(2): 194-202.
7. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr, 2015, 28(1): 1-39.e14.
8. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr, 2005, 18(12): 1440-1463.
9. Tsougos E, Paraskevaidis IA, Varounis C, et al. Long-term prognostic value of diastolic exercise echocardiography. Int J Cardiol. 2013, 169(1): e14-e16.
10. Henkel DM, Malouf JF, Connolly HM, et al. Asymptomatic left ventricular systolic dysfunction in patients with severe aortic stenosis: characteristics and outcomes. J Am Coll Cardiol. 2012, 60(22): 2325-2329.
11. Peteiro J, Bouzas-Mosquera A, Pazos P, et al. Prognostic value of exercise echocardiography in patients with left ventricular systolic dysfunction and known or suspected coronary artery disease. Am Heart J. 2010, 160(2): 301-307.
12. Szadkowska I, Pawlicki L, Kowalski J, et al. Left ventricular dysfunction and NT-proBNP levels in patients with one-vessel disease after first ST-elevation myocardial infarction treated with primary coronary angioplasty. Kardiol Pol, 2009, 67(11): 1201-1206.
13. Miszalski-Jamka T, Klimeczek P, Tomala M, et al. Extent of RV dysfunction and myocardial infarction assessed by CMR are independent outcome predictors early after STEMI treated with primary angioplasty. JACC Cardiovasc Imaging, 2010, 3(12): 1237-1246.
14. Richardson-Lobbedez M, Maréchaux S, Bauters C, et al. Prognostic importance of tissue doppler-derived diastolic function in patients presenting with acute coronary syndrome: a bedside echocardiographic study. Eur J Echocardiogr. 2008, 9(5): 594-598.
15. Khumri TM, Reid KJ, Kosiborod M, et al. Usefulness of left ventricular diastolic dysfunction as a predictor of one-year rehospitalization in survivors of acute myocardial infarction. Am J Cardiol. 2009, 103(1): 17-21.
16. Bers DM. Calcium cycling and signaling in cardiac myocytes. Annu Rev Physiol, 2008, 70: 23-49.
17. Bers DM. Altered cardiac myocyte Ca regulation in heart failure. Physiology (Bethesda). 2006, 21(6): 380-387.

West China Medical Journal

Effect of cardiac systolic and diastolic dysfunction on the prognosis of patients with coronary artery disease

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