Observational studyBMC geriatrics2025
Untangling the prognostic value of diastolic dysfunction, NT-proBNP, and frailty in older patients with preserved left ventricular ejection fraction without valvular disease.
Observational study in BMC geriatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Article
- Advances in the application of frailty scoring in the diagnosis and management of elderly patients with multiple myeloma (Review).Oncology reports · 2026Review
- Heart failure with preserved ejection fraction shows no excess mortality in older patients: a population-matched relative survival analysis.GeroScience · 2026Article
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Authors and funding
6 authors.
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Abstract
backgroundDiastolic dysfunction (DD) is a common feature in older adults, but its prognostic value is unclear.
aimThis study aims to assess the ability of DD against NT-proBNP and frailty to predict all-cause mortality, cardiovascular mortality, and a first unplanned hospitalization in older adults.
methodsSecondary analysis of the observational population-based BELFRAIL cohort of patients aged ≥ 80 years with cardiac echography at inclusion. Patients were included if LVEF ≥ 50% and without severe valvular disease. DD was defined if 50% of the criteria of the American Society of Echocardiography were fulfilled (average E/e'>14, septal e' velocity < 7 cm/s or lateral < 10 cm/s, tricuspid velocity > 2.8 m/s, left atrial volume index > 34ml/m
resultsOf the 393 patients (mean age 85 years [SD 3,6], 257 (65%) women), 185 (47%) had DD, 76 (19%) an elevated NT-proBNP, and 50 (13%) were frail. During 5.1 ± 0.2 years, 143 (36%) patients died, of whom 55 (14%) from CV causes. Crude mortality was worse (log-rank p < 0.05) for patients with DD (HR 1.48 [1.07-2.06]), elevated NT-proBNP (2.07 [HR 1.44-2.97]) or frailty (HR 3.02 [2.05-4.47]). After adjustment, DD predicted only CV mortality (HR 1.84 [1.03-3.31]). NT-proBNP predicted both all-cause (HR 1.52 [1.03-2.24]) and CV mortality (HR 2.16 [1.20-3.87]). Frailty predicted all-cause mortality (HR 2.10 [1.38-3.21]) and the first unplanned hospitalization (HR 1.62 [1.08 - 2.42]). Regarding CART, frailty was the root node for both predicting the risk of all-cause mortality and a first unplanned hospitalization. NT-proBNP was the root node in the CV mortality tree, followed by frailty.
conclusionCompared to NT-proBNP and frailty, DD offers limited added value in risk stratification for older people with preserved ejection fraction and no valvular disease. Frailty emerged as the strongest and most consistent predictor of mortality and hospitalization, and was central in the all-cause mortality and hospitalization decision-tree models.
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