Progression of Left Ventricular Diastolic Dysfunction and the Risk of Heart Failure

By G. Kane, B. L. Karon, Douglas W. Mahoney, M. Redfield, Véronique L. Roger, J. Burnett, Steven Jacobsen, R. Rodeheffer. Journal of the American Medical Association (JAMA), 2011

670 citations recorded by the source corpus.

Context Heart failure increases with advancing age, and approximately half of patients have preserved left ventricular ejection fraction. Although diastolic dysfunction plays a role in heart failure with preserved ejection fraction, little is known about age-dependent longitudinal changes in diastolic function in community populations. Objective To measure longitudinal change in diastolic function and heart failure incidence in a population-based cohort. Design 2042 randomly selected participants underwent clinical evaluation, medical record abstraction, and echocardiography (1997–2000). Diastolic left ventricular function was graded as mild, moderate, or severe by validated Doppler techniques. After four years participants were invited to return for re-examination, and 1402 did so (2001–2004). The cohort was then followed for ascertainment of new onset heart failure (2004–2010). Setting Community population; Olmsted County, Minnesota Participants Population-based cohort of persons ≥45 years old Main Outcome Measures Incident heart failure Results Over 4 ± 0.3 years diastolic dysfunction prevalence increased from 23.8% (95% CI 21.2–26.4) to 39.2% (95% CI 36.3–42.2) (P <0.001). Diastolic function grade worsened in 23.4% (95% CI 20.9–26.0) of participants, was unchanged in 67.8% (95% CI 64.9–70.6), and improved in 8.8% (95% CI 7.1–10.5). Worsened diastolic dysfunction was associated with age ≥65 years (OR 2.85; 95% CI 1.77–4.72). During 6.3 ± 2.3 years of additional follow-up, heart failure 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-severe dysfunction, respectively. (P <0.001) Diastolic dysfunction was associated with incident heart failure after adjustment for age, hypertension, diabetes, and coronary disease (HR 1.81; 95% CI 1.01–3.48). Conclusion In a population-based cohort followed for four years, diastolic dysfunction prevalence increased. Diastolic dysfunction was associated with development of heart failure during six years of subsequent follow-up.

Subfields: Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and Imaging

View Paper: https://www.semanticscholar.org/paper/51b10546a55e8498855f95d23085a820d6637c09

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In Cardiology and Cardiovascular Medicine

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  2. T. Horwich
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  4. J. Januzzi
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In Radiology, Nuclear Medicine and Imaging

  1. Frank Flachskampf
  2. Sherif F. Nagueh

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