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Background: Diastolic dysfunction (DD) is highly prevalent and associated with increased morbidity and mortality, but its natural history remains poorly defined. Objective: This cohort study sought to characterise the influence of clinical features, medical therapy and echocardiographic parameters on the progression of DD. Methods: We identified 926 consecutive patients (aged 62 (14) years, 221 women) with DD and preserved systolic function. A repeat echocardiogram was per-formed in 199 patients>1 year after the baseline study (average 3.6 (1.4) years). Follow-up for 4.8 (2.5) years was 97 % complete for the major endpoint of all-cause mortality. Cox regression analyses were performed to identify the associations of mortality