Prevalence and Predictors of Diastolic Dysfunction According to Different Classification Criteria: The Coronary Artery Risk Development in Young in Adults Study

Abstract

Heart failure with preserved ejection fraction is often preceded by diastolic dysfunction (DD). Of several published DD criteria, it is unclear which, if any, are applicable to data obtained in epidemiologic cohorts. We evaluated the prevalence of DD using previously published definitions in a population-based study, the Coronary Artery Risk Development in Young Adults (CARDIA) Study, using data gathered in 2010-2011. Echocardiography was performed on 3,474 individuals (mean age = 50.2 years) at the CARDIA year 25 examination. Four published definitions of DD were studied. We calculated DD prevalence for each definition and determined the overlap between definitions. We used logistic regression to assess the strength of associations between demographic and clinical factors and the definitions of DD. Prevalence of DD ranged from 2% to 32% across the 4 definitions, with a minority of cases identified by more than 1 definition. Two definitions classified 38%-39% of the study sample as indeterminate for DD. Associations of risk factors with DD varied considerably, with male sex being associated positively with DD for one definition (odds ratio = 1.4, 95% confidence interval: 1.2, 1.6) and inversely for another (odds ratio = 0.7, 95% confidence interval: 0.6, 0.8). Prevalence of DD varies markedly in CARDIA by the definition applied. A uniform, reliable, and accurate definition of DD for epidemiologic studies is needed.

Keywords: diastolic dysfunction; echocardiography; epidemiologic methods; heart failure.

Figure 1.

Prevalence of diastolic dysfunction according to different definitions in the Coronary Artery Risk Development in Young Adults Study (Year 25 Visit), 2010–2011. Light gray portions of columns, probably normal; medium gray portions, diastolic dysfunction; dark gray portions, normal; black portions, indeterminate. ASE, American Society for Echocardiography; VALIDD, Valsartan in Diastolic Dysfunction.

Figure 2.

Overlap between 4 different definitions of diastolic dysfunction (DD) in the Coronary Artery Risk Development in Young Adults Study (Year 25 Visit), 2010–2011. A total of 1,900 participants did not meet any case definition. ASE, American Society for Echocardiography; VALIDD, Valsartan in Diastolic Dysfunction.