Diastolic dysfunction linked to heart failure
MedWire News: Diastolic dysfunction is associated with the development of heart failure, US researchers have found.
Left ventricular dysfunction is highly prevalent in people from middle age onwards and tends to worsen over time, report Garvan Kane (Mayo Clinic, Rochester, Minnesota) and colleagues in the Journal of the American Medical Association.
Furthermore, "our data suggest that persistence or progression of diastolic dysfunction is a risk factor for heart failure in elderly persons," they continue.
The study involved 2042 participants aged 45 years or older, who were randomly selected from the Olmstead County Heart Function Study. All participants underwent clinical evaluation, medical record abstraction, and echocardiography from 1997 to 2000 (examination 1).
The researchers classified the patients according to their diastolic left ventricular function as normal, mild, moderate, or severe using pulse wave Doppler techniques.
After 4 years, 1402 of the 1960 patients who had survived returned for examination 2 (2001-2004), during which all the data collected at examination 1 was recollected. The researchers used Framingham risk criteria to diagnose the risk for incident heart failure between examinations 1 and 2 and for the duration of a subsequent follow-up period between 2004 and 2010.
The findings revealed that the prevalence of diastolic dysfunction increased from 23.8% at examination 1 to 39.2% at examination 2. Over the same duration, diastolic function grade worsened in 23.4% of participants, remained constant in 67.8% of participants, and improved in 8.8% of participants.
Participants aged 65 years or older had a 2.85-fold increased risk for worsened diastolic dysfunction.
During a mean additional follow-up period of 6.3 years, heart failure occurred in 2.6% of individuals whose diastolic function normalized or remained normal, 7.8% of those in whom it remained or progressed to mild dysfunction, and 12.2% of those in whom it remained or progressed to moderate or severe dysfunction (p<0.001).
Moreover, after adjustment for age, hypertension, diabetes, and coronary artery disease diastolic dysfunction was associated with a 1.81-fold increased risk for heart failure.
Aging may be accompanied by progressive deterioration in diastolic function, which could contribute to the pathophysiologic substrate from which overt heart failure emerges, remark the authors.
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By Piriya Mahendra