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Comparative Study
. 2012 Mar 1;5(2):144-51.
doi: 10.1161/CIRCHEARTFAILURE.110.959668. Epub 2012 Jan 25.

The natural history of preclinical diastolic dysfunction: a population-based study

Mark W Vogel  1 , Joshua P Slusser, David O Hodge, Horng H Chen
Affiliations
Comparative Study

The natural history of preclinical diastolic dysfunction: a population-based study

Mark W Vogel et al. Circ Heart Fail. .

Abstract

Background: Preclinical diastolic dysfunction (PDD) has been broadly defined as subjects with left ventricular diastolic dysfunction, without the diagnosis of congestive heart failure (HF) and with normal systolic function. Our objective was to determine the risk factors associated with the progression from PDD (stage B) HF to symptomatic (stage C) HF.

Methods and results: Using the resources of the Rochester Epidemiology Project, all residents of Olmsted County, MN, who underwent echocardiography between January 1, 2004, and December 31, 2005, and had grade 2-4 diastolic dysfunction and ejection fraction ≥50% were identified. Patients with a diagnosis of HF before or within 30 days of the echocardiogram were excluded. Patients were also excluded if they had a diagnosis of atrial fibrillation or severe mitral or aortic valve regurgitation at the time of the echocardiogram. A total of 388 patients met the inclusion criteria. The mean age of the cohort was 67±12 years, with a female (57%) predominance. Prevalence of renal insufficiency (estimated glomerular filtration rate <60 mL/min per 1.73 m(2)) was 34%. The 3-year cumulative probabilities of development of (stage C) HF, development of atrial fibrillation, cardiac hospitalization, and mortality were 11.6%, 14.5%, 17.7%, and 10.1% respectively. In multivariable Cox proportional hazard regression analysis, we determined that age, renal dysfunction, and right ventricular systolic pressure were independently associated with the development of HF.

Conclusions: This population-based study demonstrated that in PDD (stage B) HF, there was a moderate degree of progression to symptomatic (stage C) HF over 3 years, and renal dysfunction was associated with this progression independent of age, sex, hypertension, coronary disease, and ejection fraction.

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Figures

Figure 1
Figure 1
Cumulative Probability of Development of Heart Failure by Kaplan-Meier
Figure 2
Figure 2
Cumulative Probability of Development of Atrial Fibrillation by Kaplan-Meier
Figure 3
Figure 3
Cumulative Probability of Cardiac Hospitalization by Kaplan-Meier
Figure 4
Figure 4
Cumulative Probability of All Cause Mortality by Kaplan-Meier
Figure 5
Figure 5
Cumulative Probability of Heart Failure or Death by Kaplan-Meier
See this image and copyright information in PMC

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