Inverted mitral inflow pattern in echocardiography among the elderly--a marker of non-cardiovascular mortality and cognitive dysfunction

Abstract

Background: An echocardiographically measured inverted mitral inflow pattern (E/A ratio), a measure of left ventricular diastolic function, has been repeatedly shown to predict mortality. Despite its known association with several non-cardiovascular disease states, its connection to non-cardiovascular mortality remains unknown.

Methods: A total of 323 individuals aged more than 75 years were examined and followed up for a median of 7.6 years in a prospective population-based echocardiographic cohort study carried out in Eastern Finland. Cox proportional hazards regression models were used to determine the prognostic power of echocardiographic parameters on total, cardiovascular, and non-cardiovascular mortality, with special interest on inverted E/A ratio.

Results: The left ventricular mass index was a significant predictor of total and cardiovascular mortality. It had no connection to non-cardiovascular mortality. Inverted E/A ratio was associated with total mortality in the age- and sex-adjusted (HR = 1.54; 95% CI = 1.14-2.07) as well as in the fully adjusted multivariable model (HR = 1.55; 95% CI = 1.10-2.19). Regarding cardiovascular mortality, the inverted E/A ratio showed no predictive value in the age- and sex-adjusted (HR = 1.24; 95% CI = 0.80-1.91) or the fully adjusted (HR = 1.31; 95% CI = 0.78-2.22) models. Inverted E/A was a strong predictor of non-cardiovascular mortality in both the age- and sex-adjusted model (HR = 1.86; 95% CI = 1.24-2.80) and the multivariable model (HR = 1.81; 95% CI = 1.13-2.89). Dementive illness was the only prior disease more common among individuals with an inverted mitral inflow pattern.

Conclusions: An echocardiographically measured inverted mitral inflow pattern is a robust predictor of total and non-cardiovascular mortality among the elderly general population, with no significant connection to cardiovascular mortality.