Progression of Left Ventricular Diastolic Dysfunction and Risk of Heart Failure

Study Questions:

What are the changes in diastolic function over time, and what is the relationship between diastolic dysfunction and the risk of subsequent heart failure (HF)?

Methods:

The study cohort was comprised of participants (ages ≥45 years) enrolled in the Olmsted County Heart Function Study. A total of 2,042 participants from a population of 112,255 (90% were white, 81% were urban, and 11% were age ≥65 years) who were randomly selected (n = 2,042) underwent clinical evaluation, medical record abstraction, and echocardiography (examination 1 [1997-2000]). Diastolic left ventricular function was graded as normal, mild, moderate, or severe by using Doppler echocardiography. The participants were invited to return for examination 2 (2001-2004), after 4 years from initial evaluation. The cohort of participants returning for examination 2 (n = 1,402 of 1,960 surviving [72%]) then underwent follow-up for ascertainment of new-onset HF (2004-2010). The main outcome measures were change in diastolic function grade and incident HF.

Results:

The study investigators found that between examinations 1 and 2, the prevalence of diastolic dysfunction increased from 23.8% (95% confidence interval [CI], 21.2%-26.4%) to 39.2% (95% CI, 36.3%-42.2%) (p < 0.001). Also, the grade of diastolic function worsened in 23.4% (95% CI, 20.9%-26.0%) of participants, was unchanged in 67.8% (95% CI, 64.8%-70.6%), and improved in 8.8% (95% CI, 7.1%-10.5%). Worsened diastolic dysfunction was associated with age 65 years or older (odds ratio, 2.85; 95% CI, 1.77-4.72). During 6.3 (standard deviation, 2.3) years of additional follow-up, HF occurred in 2.6% (95% CI, 1.4%-3.8%), 7.8% (95% CI, 5.8%-13.0%), and 12.2% (95% CI, 8.5%-18.4%) of persons whose diastolic function normalized or remained normal, remained or progressed to mild dysfunction, or remained or progressed to moderate or severe dysfunction, respectively (p < 0.001). They reported that diastolic dysfunction was associated with incident HF after adjustment for age, hypertension, diabetes, and coronary artery disease (hazard ratio, 1.81 [95% CI, 1.01-3.48]).

Conclusions:

The authors of the study concluded that in a population-based cohort, prevalence of diastolic dysfunction increased during the 4-year follow-up period. They also found that diastolic dysfunction was associated with development of HF during 6 years of subsequent follow-up.

Perspective:

This is an important study that clearly delineates the natural history of diastolic dysfunction in a cohort with a mean age >60 years. It suggests that diastolic dysfunction as detected by Doppler is a predictor of future HF. Further studies are needed to determine whether aggressive management of diabetes, hypertension, and coronary artery disease will slow the progression of diastolic dysfunction and the development of overt HF. Also, studies are needed to determine whether the rapidity of progression of diastolic dysfunction is similar in other ethnic populations such as African-Americans.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension

Keywords: Prevalence, Coronary Artery Disease, Follow-Up Studies, Ventricular Function, Left, Heart Failure, Diastole, Hypertension, Diabetes Mellitus, United States, Echocardiography


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