Prevalence of Left Ventricular Diastolic Dysfunction

 in a General Population

Tatiana Kuznetsova^1,4; Lieven Herbots¹; Begoña López²; Yu Jin¹; Tom Richart³; Lutgarde Thijs¹; Arantxa González²;Marie-Christine Herregods¹; Robert H. Fagard¹; Javier Díez² and Jan A. Staessen³

¹ University of Leuven;
² Center for Applied Medical Research, Pamplona;
³ University of Leuven and University of Maastricht

⁴ E-mail: tatiana.kouznetsova@med.kuleuven.be

Background—Because the process of myocardial remodelling starts before the onset of symp-toms, 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-pro-brain natriuretic peptide (NT-proBNP) 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), and pulmonary vein (PV) flow by pulsed wave Doppler, and the mitral annular velocities (Ea and Aa) at four sites by Tissue Doppler Imaging. A healthy subsample of 239 subjects (mean age, 43.7 years) provided age-specific cut-off limits for normal E/A, E/Ea ratios, and the differences in duration between the mitral A and the reverse PV 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 <> pressures in group 2. Compared to subjects with normal diastolic function (n=392, 72.7%), group 1 (209 vs 251 pmol/L; P=0.015) and group 2 (209 vs 275 pmol/L; P=0.0003), but not group 3 (209 vs 224 pmol/L; P=0.65) had a significantly higher adjusted NT-proBNP. 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%.