Over time, worsening
diastolic dysfunction associated with increased risk of developing
heart failure
A follow-up of participants in a heart function
study finds that the prevalence of left ventricular diastolic dysfunction
had increased; that diastolic function had worsened in a nearly
a quarter of patients; and that participants who had diastolic dysfunction
were more likely to develop heart failure, according to a study
in the August 24/31 issue of JAMA.
"There is an emerging emphasis on understanding the progression
from heart failure risk factors to asymptomatic ventricular dysfunction
and eventually to symptomatic heart failure and death. Therefore,
it is important to have population-based information on changes
in cardiac function over time," according to background information
in the article. "… little is known about time-dependent changes
in diastolic function or their relationship to clinical heart failure."
Garvan C. Kane, M.D., Ph.D., of the Mayo Clinic and Medical School,
Rochester, Minn., and colleagues conducted a study to measure changes
in diastolic function over time and to determine the relationship
between diastolic dysfunction and the risk of subsequent heart failure.
The study included participants enrolled in the Olmsted County Heart
Function Study (OCHFS). Randomly selected participants 45 years
or older (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 via testing. After 4 years, participants were invited
to return for examination 2 (2001-2004). The group of participants
returning for examination 2 (n = 1,402 of 1,960 surviving [72 percent])
then underwent follow-up testing for determination of new-onset
heart failure (2004-2010).
The researchers found that from examination 1 to examination 2,
the prevalence of diastolic dysfunction of any degree increased
from 23.8 percent to 39.2 percent. Moderate or severe diastolic
dysfunction increased from 6.4 percent to 16.0 percent. Over 4 years,
23.4 percent of participants experienced worsening of diastolic
function, 67.8 percent remained unchanged, and 8.8 percent experienced
improved diastolic function. Age was predictive of the development
of diastolic dysfunction, especially ages 65 years or older.
In the analysis of the diastolic function of healthy participants
(without hypertension, diabetes, coronary artery disease, heart
failure, or use of cardiovascular medications), incidence of diastolic
dysfunction of any degree increased from 11.3 percent at examination
1 to 29.8 percent at examination 2. Among 423 healthy participants,
19.9 percent showed worsening diastolic function, 75.2 percent remained
the same, and 5.0 percent improved.
During 6.3 years of additional follow-up, 81 participants developed
heart failure. Age 65 years or older was the strongest predictor
of heart failure. The authors found that persistent or worsening
diastolic dysfunction was associated with heart failure. "Cumulative
heart failure incidence was 2.6 percent in participants whose diastolic
function remained normal or normalized between examinations; 7.8
percent in those with persistent, or progression to mild diastolic
dysfunction; and 12.2 percent in those with persistent, or progression
to moderate or severe diastolic dysfunction."
"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. Worsening diastolic function can be detected
even in apparently healthy persons. Although confirmation in other
studies would be helpful, our data suggest that persistence or progression
of diastolic dysfunction is a risk factor for heart failure in elderly
persons," the researchers conclude.
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