PT - JOURNAL ARTICLE AU - Yuta Seko AU - Takao Kato AU - Masayuki Shiba AU - Yusuke Morita AU - Yuhei Yamaji AU - Yoshizumi Haruna AU - Eisaku Nakane AU - Hideyuki Hayashi AU - Tetsuya Haruna AU - Moriaki Inoko TI - Association of the low e′ and high E/e′ with long-term outcomes in patients with normal ejection fraction: a hospital population-based observational cohort study AID - 10.1136/bmjopen-2019-032663 DP - 2019 Nov 01 TA - BMJ Open PG - e032663 VI - 9 IP - 11 4099 - http://bmjopen.bmj.com/content/9/11/e032663.short 4100 - http://bmjopen.bmj.com/content/9/11/e032663.full SO - BMJ Open2019 Nov 01; 9 AB - Objective We aimed to evaluate the association of the severity of left ventricular (LV) diastolic dysfunction with long-term outcomes in patients with normal ejection fraction.Design Retrospective study.Setting A single centre in Japan.Participants We included 3576 patients who underwent both scheduled transthoracic echocardiography and ECG between 1 January and 31 December 2013, in a hospital-based population after excluding valvular diseases or low ejection fraction (<50%) or atrial fibrillation and categorised them into three groups: septal tissue Doppler early diastolic mitral annular velocity (e′)≥7 (without relaxation disorder, n=1593), e′<7 and early mitral inflow velocity (E)/e′≤14 (with relaxation disorder and normal LV end-diastolic pressure, n=1337) and e′<7 and E/e′>14 (with relaxation disorder and high LV end-diastolic pressure, n=646).Primary and secondary outcome measures The primary outcome measure was a composite of all-cause death and major adverse cardiac events (MACE). The secondary outcome measure were all-cause death and MACE, separately.Results The cumulative 3-year incidences of the primary outcome measures were significantly higher in the e′<7 and E/e′≤14 (19.0%) and e′<7 and E/e′>14 group (23.4%) than those for the e′≥7 group (13.0%; p<0.001). After adjusting for confounders, the excess 3-year risk of primary outcome for the groups with e′<7 and E/e′≤14 related to e′≥7 (HR: 1.24; 95% CI 1.02 to 1.52) and e′<7 and E/e′>14 related to e′<7 (HR: 1.57; 95% CI 1.28 to 1.94) were significant. The severity of diastolic dysfunction was associated with incrementally higher risk for primary outcomes (p<0.001).Conclusion The severity of LV diastolic dysfunction using e′<7 and E/e′>14 was associated with the long-term prognosis in patients with normal ejection fraction in an incremental fashion.