Published online before print February 10, 2009, doi: 10.1161/CIRCHEARTFAILURE.108.822627
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Original Articles |
Prevalence of Left Ventricular Diastolic Dysfunction in a General Population
From the Studies Coordinating Centre (T.K., Y.J., T.R., L.T., R.H.F., J.A.S.), Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium; Department of Epidemiology (T.R., J.A.S.), University of Maastricht, Maastricht, The Netherlands; Division of Cardiology (L.H., M.-C.H.), Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium; Division of Cardiovascular Sciences (B.L., A.G., J.D.), Centre for Applied Medical Research, Pamplona, Spain.
Correspondence to Tatiana Kuznetsova, MD, PhD, Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Campus Gasthuisberg, Herestraat 49, Box 702, B-3000 Leuven, Belgium. E-mail tatiana.kouznetsova{at}med.kuleuven.be
Received September 24, 2008; accepted November 30, 2008.
Background— Because the process of myocardial remodelling starts before the onset of symptoms, recent heart failure (HF) guidelines place special emphasis on the detection of subclinical left ventricular (LV) systolic and diastolic dysfunction and the timely identification of risk factors for HF. Our goal was to describe the prevalence and determinants (risk factors) of LV diastolic dysfunction in a general population and to compare the amino terminal probrain natriuretic peptide level across groups with and without diastolic dysfunction.
Methods and Results— In a randomly recruited population sample (n=539; 50.5% women; mean age, 52.5 years), we measured early and late diastolic peak velocities of mitral inflow (E and A), pulmonary vein flow by pulsed-wave Doppler, and the mitral annular velocities (Ea and Aa) at 4 sites by tissue Doppler imaging. A healthy subsample of 239 subjects (mean age, 43.7 years) provided age-specific cutoff limits for normal E/A and E/Ea ratios and the differences in duration between the mitral A and the reverse pulmonary vein flows during atrial systole (
Ad–ARd). The number of subjects in diastolic dysfunction groups 1 (impaired relaxation), 2 (elevated LV end-diastolic filling pressure), and 3 (elevated E/Ea and abnormally low E/A) were 53 (9.8%), 76 (14.1%), and 18 (3.4%), respectively. We used (Ad<ARd+10) to confirm possible elevation of LV filling pressures in group 2. Compared with subjects with normal diastolic function (n=392, 72.7%), group 1 (209 versus 251 pmol/L; P=0.015) and group 2 (209 versus 275 pmol/L; P=0.0003) but not group 3 (209 versus 224 pmol/L; P=0.65) had a significantly higher adjusted NT-probrain natriuretic peptide. Higher age, body mass index, heart rate, systolic blood pressure, serum insulin, and creatinine were significantly associated with a higher risk of LV diastolic dysfunction.
Conclusions— The overall prevalence of LV diastolic dysfunction in a random sample of a general population, as estimated from echocardiographic measurements, was as high as 27.3%.
Key Words: epidemiology • echocardiography • tissue Doppler imaging • diastole
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