2 hypertrophic cardiomyopathy, congenital heart disease, end- stage renal disease on maintenance hemodialysis, or malig- nant neoplasms were included. Medication status and a history of coronary revascularization were determined by review of medical records. Hypertension was deﬁned as systolic blood pressure >140 mmHg and/or diastolic blood pressure >90 mmHg measured by indirect arm-cuﬀ sphyg- momanometry at rest or use of antihypertensive drugs. Dia- betes was deﬁned as a fasting blood glucose level >126 mg/dL or treatment with dietary modiﬁcation, insulin, or oral hypo- glycemic agents. Dyslipidemia was deﬁned as low-density li- poprotein level ≥140 mg/dL, high-density lipoprotein level <40 mg/dL, and/or triglyceride level ≥150 mg/dL or treat- ment with antihyperlipidemic agents. Within a week before the index cardiac catheterization for this study, blood chem- istry was obtained for assessment of clinical features. All the patients gave written informed consents to participate in the study, and this study was performed according to the regula- tions proposed by the Ethical Guidelines Committee of the Nagoya City University Graduate School of Medical Sciences. 2.2. Cardiac Catheterization. Before contrast material was injected into the LV or coronary artery, LV and aortic pres- sure waves were obtained with a catheter-tipped micromano- meter (SPC-454D, Millar Instrument Company, Houston, TX) and recorded on a polygraph system (RMC-2000, Nihon Kohden, Inc., Tokyo, Japan) as previously reported [11]. From the recorded pressure waves, aortic systolic and diastol- ic pressures and LV end-diastolic pressure (EDP) were deter- mined. A time constant of decrease in LV pressure (Tau), an index of early diastolic relaxation, was computed by applying a monoexponential ﬁtting with zero asymptote to the LV pressure decay [12]. LV end-systolic and end-diastolic vol- umes were obtained from biplane left ventriculography by use of the method proposed by Chapman et al. [13] and were used for calculating ejection fraction (EF). The median val- ues of measurements of 3 consecutive beats were used for statistical analyses. 2.3. Echocardiography. The day before the index cardiac catheterization, ultrasound examination was performed with the use of a commercially available echocardiographic ma- chine (APLIO 80, Toshiba, Tokyo) with a 3-MHz transducer. Patients were examined at rest in the left lateral decubitus position. LV diastolic function was evaluated according to the published guideline [14]. Transmitral ﬂow velocities during early diastole (E) and atrial contraction (A) at the mitral oriﬁce were obtained with the use of pulsed Doppler echocardiography in the apical 4-chamber view. Deceleration time was measured as the time from the peak early ﬁlling velocity to termination of early ﬁlling. The peak early diastolic annular velocity (e ) was measured with the use of pulsed Doppler echocardiography at the septal and lateral mitral annular sites. The values of e measured at both sites were averaged. The median values of measurements of 3 consecutive beats were used for statistical analyses. LV mass was calculated from M-mode echocardiographic measure- ments [15] and LV mass was corrected for body surface area. Cardiology Research and Practice 2.4. Followup. Followup was determined in October 2010 with the use of the medical record and/or at regular visit to determine the patients’ vital status and any cardiovascular hospitalizations. The outcome of the present study was car- diac death (acute myocardial infarction, heart failure, and sudden cardiac death) or unscheduled admission for car- diovascular causes. Sudden cardiac death was deﬁned as unexpected death within one hour after the onset of a new symptom, or unexpected, unobserved death. 2.5. Statistical Analysis. We used the SAS program package (SAS Institute, Cary, NC) for statistical analyses. Diﬀerences in quantitative and categorical data at baseline between groups were compared by the Student’s t-test and the Fisher exact probability test. The association between continuous variables was determined by Pearson’s correlation analysis. Survival curves of patients stratiﬁed by LV function indices were calculated by the Kaplan-Meier method and compared using the log-rank test. EDP of 16 mmHg, Tau of 48 ms, and EF of 50% were used as cut-oﬀ points, because these values are established thresholds for separating normal and abnor- mal levels [1]. In contrast, reported cut-oﬀ points of echocar- diographic diastolic measures (e and E/e ) for the diagnosis of diastolic dysfunction or the prediction of adverse progno- sis are variable depending on age [2] and population studied [4]. Furthermore, e recorded at lateral mitral annular site is usually higher than e at septal site [4]. Thus, in the present study, the best cut-oﬀ points of echocardiographic diastolic measures were explored to maximize the likelihood ratio in receiver-operating characteristic curves for the prediction of the outcome. Hazard ratio of clinical variables for the outcome was determined using the Cox proportional hazards regression analysis. To assess the independent predictive value of LV function indices, the multivariate Cox hazards regression analyses were performed including potential con- founders based on the ﬁndings of previous studies and the results of univariate analyses. Multivariate model 1 included age, sex, hypertension, dyslipidemia, diabetes, and coronary revascularization after the index cardiac catheterization. Multivariate model 2 included previous history of myocar- dial infarction, the number of coronary arteries narrowed, EF, systolic aortic pressure, and heart rate. Multivariate model 3 included use of cardiovascular medications. Data are presented as the mean ± SD. Risk for death or cardiovascular hospitalization is presented as hazard ratio (HR) with 95% conﬁdence interval (CI). P < 0.05 was considered signiﬁcant. 3. Results Based on the ﬁndings of the index coronary angiography, 50 percutaneous coronary interventions and 2 coronary artery bypass surgeries were performed. During a followup of 1364 ± 628 (median (range), 1444 (16–2433)) days, 5 car- diac deaths (4 heart failure and 1 sudden cardiac death) and 20 hospitalizations due to cardiovascular causes (15 ischemic myocardial events (14 unstable angina and 1 acute myocar- dial infarction), 3 heart failure, and 2 arrhythmia) were observed. Clinical, hemodynamic, and echocardiographic features of all patients and patient subgroups are shown