Abstract 17428: Severity of Diastolic Dysfunction Predicts Risk of Myocardial Infarction

Background: Diastolic dysfunction (DD) is known to be a predictor of mortality. However, the impact of DD on the risk for myocardial infarction (MI) is not well defined.

Research Question: We sought to examine whether DD is an independent predictor of risk of MI in patients with a preserved ejection fraction.

Methods: This was a retrospective study of consecutive patients who underwent an echocardiogram that showed normal systolic function and had ≥3 months of follow-up. DD was graded using the contemporaneous guidelines at the time of the echocardiogram. Subsequent MI was determined by the presence of an inpatient encounter with a primary diagnosis of MI.

Results/Data: 136,455 patients were included (mean age 56 years; 58% women). DD was present in 18.3% of patients (14.1% Grade 1, 3.8% Grade 2, 0.4% Grade 3). Patients with DD were more likely to be older (71 vs 53 years) and have coronary artery disease (27% vs 12%), diabetes (27% vs 14%), hypertension (69% vs 47%) and hyperlipidemia (64% vs 41%), among other comorbidities. Survival free from MI was significantly lower as diastolic dysfunction severity increased (Figure 1). Multivariate Cox proportional hazards modeling demonstrated that DD was an independent predictor of MI (hazard ratios [CI]: Grade 1: 1.51 [1.35-1.69]; Grade 2: 1.92 [1.64-2.25]; Grade 3: 2.82 [1.94-4.09]).

Conclusions: Our data demonstrate that the risk of MI is significantly increased in the presence of DD, with higher risk at higher grades of DD. The increased risk associated with grade 3 DD is comparable to that from a prior history of coronary artery disease. These findings suggest that the severity of DD may be a useful tool in risk stratifying patients for risk of MI.