Cardiology Research and Practice )%100 ( n o i t a z i l ita 90 p s o h V C fo 80 e e r f l a v i rvu 70 S Number of risk τ ≤ 48 ms τ > 48 ms 0 127 95 Echocardiographic indices E/A Deceleration time, ms e cm/s E/e Left ventricular mass index, g/m2 Long rank, 5.5 P < 0.05 τ ≤ 48 ms τ > 48 ms ()%100 n o i t a z i l ita 90 p s o h V C fo 80 e e r f l a v i v ru 70 S Long rank, 13.2 P < 0.01 500 1000 Followup (days) 111 81 (a) 100 70 1500 65 40 Number of risk E ≥ 5.8 cm/s E < 5.8 cm/s 0 153 69 500 1000 Followup (days) 134 58 (b) 120 50 Figure 1: Kaplan-Meier survival curves of patients stratiﬁed by left ventricular relaxation time constant (Tau) and early diastolic mitral annular velocity (e ). CV indicates cardiovascular. Table 3: Echocardiographic feature of patient subgroups stratiﬁed by left ventricular relaxation time constant (Tau) and peak early diastolic mitral annular velocity (e ). ≤48 ms (n = 127) 0.79 ± 0.23 218 ± 48 7.5 ± 2.0 8.8 ± 2.8 99.8 ± 24.5 Tau >48 ms (n = 95) 0.90 ± 0.55 201 ± 52 6.4 ± 1.9 10.6 ± 3.7 120.7 ± 26.9 P value 0.05 NS <0.001 <0.001 <0.001 ≥5.8 cm/s (n = 153) 0.87 ± 0.33 210 ± 51 8.0 ± 1.6 8.3 ± 2.3 101.5 ± 25.4 e <5.8 cm/s (n = 69) 0.77 ± 0.54 214 ± 49 4.8 ± 0.8 12.4 ± 3.6 122.9 ± 26.5 EDP, and LV volumes and lower levels of systolic aortic pressure and EF. Compared with patients with e ≥ 5.8 cm/s, those with e < 5.8 cm/s were more likely to have greater number of coronary arteries narrowed and higher levels of Tau, EDP, and LV volumes and lower levels of EF. Patients who were diagnosed to have abnormal LV relaxation by both cardiac catheterization and Doppler echocardiography (Tau > 48 ms and e < 5.8 cm/s (n = 41)) were more likely to be older, to have history of myocardial infarction, to be higher in serum creatinine levels, LV vol- ume, and LV mass index, and to be lower in EF, compared with those who were diagnosed to have abnormal LV re- laxation by only one modality (n = 82). After adjustment for potential confounders (traditional cardiovascular risk factors, the severity of CAD, and car- diovascular medications, coronary revascularization after the index cardiac catheterization), the predictive value of Tau > 48 ms continued to be signiﬁcant (Table 4). Similar adjustment revealed the independent predictive value of e < 5.8 cm/s (Table 4). Modest but signiﬁcant correlations were observed be- tween LV diastolic function indices determined by cardiac catheterization and those by Doppler echocardiography; Tau correlated with e (r = −0.26, P < 0.001) and E/e (r = 0.26, P < 0.001) and EDP correlated with E/e (r = 0.23, P < 0.001) but not with e (r = −0.08, P = 0.3). 4. Discussion In the present study, we found that Tau > 48 ms and e < 5.8 cm/s were each associated with an increased risk for car- diac death or subsequent cardiovascular hospitalization in patients undergoing cardiac catheterization for CAD. In con- trast, no prognostic value was observed in EDP, E/e , or EF. Although studies have reported that LV diastolic abnor- malities assessed by Doppler echocardiography are predictive of cardiac mortality and morbidity in patients with myocar- dial infarction [5], those with heart failure with preserved EF [7], those with reduced EF [8], and hypertensive subjects [6, 9], only a few studies have examined the predictive value of invasively-determined diastolic dysfunction. Speciﬁcally, Liang et al. examined the prognostic value of EDP as well as Doppler echocardiographic diastolic measures in patients undergoing cardiac catheterization for CAD [16]. They E ≥ 5.8 cm/s E < 5.8 cm/s 5 1500 80 25 P value NS NS <0.001 <0.001 <0.001