Incremental prognostic value of diastolic dysfunction in low risk patients undergoing echocardiography: Beyond Framingham score

Wael A. AlJaroudi, M. Chadi Alraies, Carmel Halley, Venu Menon, L. Leonardo Rodriguez, Richard A. Grimm, James D. Thomas, Wael A. Jaber

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


We sought to assess the prognostic value of diastolic dysfunction (DD) in low-risk adults beyond Framingham risk score (FRS). Consecutive patients without cardiovascular risk factors or co-morbidities were identified from a retrospective cohort. Multivariate binary logistic regression was performed to identify factors associated with DD, and Cox proportional hazard model to evaluate the association of DD with all-cause death. Analysis was repeated by stratifying by the year of the echocardiogramto account for possible time-related shift in measurement techniques. Net reclassification improvement (NRI) was performed to assess incremental prognostic value of DD. The study cohort consisted on 1,039 patients with a mean age (SD) 47.9 (15.7) years. Overall, 346 patients (33.3 %) had DD, among whom 327 were grade 1. Age was the only independent predictor of DD with odds ratio 3.2 (2.8; 3.7) for every 10 years increase (p<0.0001). After a mean follow-up time (SD) of 7.3 (1.7) years, 71 (6.8 %) patients died. Adjusting for age, gender, and race, DD remained an independent predictor of all-cause mortality with hazard ratio (95 % CI) 2.03 (p = 0.029), and similarly after adjusting for FRS (HR 2.73, p = 0.002) which resulted in IDI gain of 1.4 %(p = 0.0037) andNRI of 15 %(p = 0.029). In 463 age and gendermatched subgroups,DD was still an independent predictor of mortality (HR 2.6 [1.25; 5.55], p = 0.01). In low-risk adult outpatients undergoing echocardiography, DD was associated with 2-3 fold increase in risk of death and had incremental prognostic value beyond FRS.

Original languageEnglish (US)
Pages (from-to)1441-1450
Number of pages10
JournalInternational Journal of Cardiovascular Imaging
Issue number7
StatePublished - Oct 2013
Externally publishedYes


  • Diastolic function
  • Framingham risk score
  • Low risk outpatients
  • Outcomes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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