JAMA: Diastolic dysfunction associated with HF

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Diastolic dysfunction was linked to incidence of heart failure (HF) in an elderly population, according to a study published in the Aug. 24/31 issue of the Journal of the American Medical Association. The authors concluded that left ventricular diastolic dysfunction is prevalent and worsens over time, especially with age.

“Heart failure may develop with reduced or preserved left ventricular ejection fraction (LVEF), each form accounting for approximately half of cases,” Garvan C. Kane, MD, PhD, of the Mayo Clinic in Rochester, Minn., and colleagues wrote. “Echocardiographic classifications of diastolic function in cross-sectional community studies has shown diastolic dysfunction to be highly prevalent and associated with heart failure.”

Because little is known about time-dependent changes in diastolic function or their relationship to clinical heart failure, Kane and colleagues used the Olmsted County Heart Function Study (OCHFS) to identify 2,042 patients 45 years or older. The patients all underwent clinical evaluation and echocardiography and the researchers used Doppler techniques to grade left ventricular function as normal, mild, moderate or severe.The researchers used change in diastolic function grade and heart failure as the study’s primary outcome. After four years, patients returned for examination and underwent follow-up for incidence of new-onset HF.

Kane et al found that diastolic dysfunction increased from 23.8 percent to 39.2 percent between exams one and two. Diastolic function grade worsened in 23.4 percent of participants and was unchanged in 67.8 percent of patients. Function improved in 8.8 percent of patients.

After 6.3 years of follow-up, the researchers reported that HF occurred in 2.6 percent of patients whose diastolic function remained normal or normalized. Additionally, HF occurred in 7.8 percent of patients who progressed to mild dysfunction and 12.2 percent of patients who progressed or remained at moderate or severe dysfunction.

The authors reported that diastolic dysfunction was linked to incidence of HF, even after adjustment for age, hypertension, diabetes and coronary artery disease.

“[T]o put diastolic dysfunction in context, it should be noted that only about one in four persons with moderate or severe diastolic dysfunction at examination two developed incident heart failure during long-term follow-up,” they wrote. “This suggests that superimposed clinical events play an important role in the transition from asymptomatic diastolic dysfunction to overt heart failure with preserved LVEF.”

The authors noted that the study results could impact clinical practice because the prevention of risk factors such as hypertension could significantly reduce HF with preserved LVEF.

“Longitudinal evaluation of participants in the population-based OCHFS cohort reveals that left ventricular diastolic dysfunction is highly prevalent, tends to worsen over time, and is associated with advancing age,” Kane and colleagues concluded.