Document Detail


Progression of left ventricular diastolic dysfunction and risk of heart failure.
MedLine Citation:
PMID:  21862747     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Heart failure incidence increases with advancing age, and approximately half of patients with heart failure have preserved left ventricular ejection fraction. Although diastolic dysfunction plays a role in heart failure with preserved ejection fraction, little is known about age-dependent longitudinal changes in diastolic function in community populations.
OBJECTIVE: To measure changes in diastolic function over time and to determine the relationship between diastolic dysfunction and the risk of subsequent heart failure.
DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort of participants enrolled in the Olmsted County Heart Function Study. Randomly selected participants 45 years or older (N = 2042) underwent clinical evaluation, medical record abstraction, and echocardiography (examination 1 [1997-2000]). Diastolic left ventricular function was graded as normal, mild, moderate, or severe by validated Doppler techniques. After 4 years, participants were invited to return for examination 2 (2001-2004). The cohort of participants returning for examination 2 (n = 1402 of 1960 surviving [72%]) then underwent follow-up for ascertainment of new-onset heart failure (2004-2010).
MAIN OUTCOME MEASURES: Change in diastolic function grade and incident heart failure.
RESULTS: During the 4 (SD, 0.3) years between examinations 1 and 2, diastolic dysfunction prevalence increased from 23.8% (95% confidence interval [CI], 21.2%-26.4%) to 39.2% (95% CI, 36.3%-42.2%) (P < .001). Diastolic function grade worsened in 23.4% (95% CI, 20.9%-26.0%) of participants, was unchanged in 67.8% (95% CI, 64.8%-70.6%), and improved in 8.8% (95% CI, 7.1%-10.5%). Worsened diastolic dysfunction was associated with age 65 years or older (odds ratio, 2.85 [95% CI, 1.77-4.72]). During 6.3 (SD, 2.3) years of additional follow-up, heart failure occurred in 2.6% (95% CI, 1.4%-3.8%), 7.8% (95% CI, 5.8%-13.0%), and 12.2% (95% CI, 8.5%-18.4%) of persons whose diastolic function normalized or remained normal, remained or progressed to mild dysfunction, or remained or progressed to moderate or severe dysfunction, respectively (P < .001). Diastolic dysfunction was associated with incident heart failure after adjustment for age, hypertension, diabetes, and coronary artery disease (hazard ratio, 1.81 [95% CI, 1.01-3.48]).
CONCLUSIONS: In a population-based cohort undergoing 4 years of follow-up, prevalence of diastolic dysfunction increased. Diastolic dysfunction was associated with development of heart failure during 6 years of subsequent follow-up.
Authors:
Garvan C Kane; Barry L Karon; Douglas W Mahoney; Margaret M Redfield; Veronique L Roger; John C Burnett; Steven J Jacobsen; Richard J Rodeheffer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  306     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-24     Completed Date:  2011-08-25     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  856-63     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aging
Diastole
Disease Progression
Female
Heart Failure / epidemiology,  etiology*
Humans
Longitudinal Studies
Male
Middle Aged
Minnesota / epidemiology
Risk
Severity of Illness Index
Ventricular Dysfunction, Left / complications*
Grant Support
ID/Acronym/Agency:
1UL1RR024150/RR/NCRR NIH HHS; AR-36582/AR/NIAMS NIH HHS; HL-63281/HL/NHLBI NIH HHS; HL-R01-55502/HL/NHLBI NIH HHS; NHLBI R01-55502//PHS HHS; R01 AG034676/AG/NIA NIH HHS; R01 AG034676-47/AG/NIA NIH HHS; R01 HL055502-08/HL/NHLBI NIH HHS; R01 HL063281/HL/NHLBI NIH HHS; R01 HL063281-08/HL/NHLBI NIH HHS; R01-AG034676/AG/NIA NIH HHS; UL RR024150/RR/NCRR NIH HHS; UL1 RR024150/RR/NCRR NIH HHS; UL1 RR024150-06/RR/NCRR NIH HHS
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