Mp-453090-3 the impact of diastolic dysfunction by echocardiography on the risk of cardiac arrest

Most cardiac arrests (CA) happen in patients without known cardiomyopathy. Diastolic dysfunction (DD) may be a cardiac stressor, causing increased ventricular wall tension and oxygen demand, and decreased diastolic microvascular perfusion. To investigate the association of diastolic dysfunction (DD) by echocardiography with the risk of CA. A total of 219,667 patients at a large academic medical center who underwent at least one cardiac echocardiogram between 2010 and 2022 and who had greater than 3 months of follow-up were included in this analysis. Patients with prior history of CA (n=742, 0.3%) were excluded. Natural language processing was used to categorize patients into 4 groups, based on the most severe DD assessment: Normal (n=121,160, 55.3%), Trace/Mild (n=25,110, 11.5%), Moderate (n=8,397, 3.8%), and Moderately-severe or Severe (n=1,937, 0.9%). Patients who could not be classified (n=62,321, 28.5%) were excluded. Patients were followed to the endpoint of CA, through November 2022. The final cohort included 156,604 patients (age=58±18 years; 55.4% women; ejection fraction (EF)=56.2±8.1%). Over a median follow-up of 3.02 years, 3,203 (1.5%) patients suffered a CA. An increase in the severity of DD by 1 category was associated with more than 2-fold increase in the risk of CA (Hazard Ratio (HR)=2.36, P<0.001, Figure). After adjusting for age, EF, and the Elixhauser comorbidity index, each 1 category increase in DD severity was still associated with 42% increase in the risk of CA (HR=1.42, P<0.001). Similar results were noted when excluding all patients with any EF<50%, with a 42% increase in the adjusted risk of CA for each 1 category increase in DD severity (HR=1.42, P<0.001). DD is a strong, independent predictor of CA, regardless of systolic ventricular function. DD should be considered when assessing the risk of CA at a population level.