Context Heart failure increases with advancing age, and approximately half of patients 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 longitudinal change in diastolic function and heart failure incidence in a population-based cohort. Design 2042 randomly selected participants underwent clinical evaluation, medical record abstraction, and echocardiography (1997–2000). Diastolic left ventricular function was graded as mild, moderate, or severe by validated Doppler techniques. After four years participants were invited to return for re-examination, and 1402 did so (2001–2004). The cohort was then followed for ascertainment of new onset heart failure (2004–2010). Setting Community population; Olmsted County, Minnesota Participants Population-based cohort of persons ≥45 years old Main Outcome Measures Incident heart failure Results Over 4 ± 0.3 years diastolic dysfunction prevalence increased from 23.8% (95% CI 21.2–26.4) to 39.2% (95% CI 36.3–42.2) (P <0.001). Diastolic function grade worsened in 23.4% (95% CI 20.9–26.0) of participants, was unchanged in 67.8% (95% CI 64.9–70.6), and improved in 8.8% (95% CI 7.1–10.5). Worsened diastolic dysfunction was associated with age ≥65 years (OR 2.85; 95% CI 1.77–4.72). During 6.3 ± 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-severe dysfunction, respectively. (P <0.001) Diastolic dysfunction was associated with incident heart failure after adjustment for age, hypertension, diabetes, and coronary disease (HR 1.81; 95% CI 1.01–3.48). Conclusion In a population-based cohort followed for four years, diastolic dysfunction prevalence increased. Diastolic dysfunction was associated with development of heart failure during six years of subsequent follow-up.

These data suggest that DD contributes to LA remodeling. Indeed, DD is a stronger predictor of mortality; presumably it better reflects the impact of CV disease within the general population.

Objective To compare the prevalence of left ventricular (LV) diastolic dysfunction in subjects with and without rheumatoid arthritis (RA), among those with no history of heart failure (HF), and to determine risk factors for diastolic dysfunction in RA. Methods We conducted a cross-sectional, community-based study comparing cohorts of adult RA and non-RA subjects without a history of HF. Standard 2D/Doppler echocardiography was performed in all participants. Diastolic dysfunction was defined as impaired relaxation (with or without increased filling pressures) or advanced reduction in compliance or reversible or fixed restrictive filling. Results The study included 244 RA subjects and 1448 non-RA subjects. Mean age was 60.5 years in the RA cohort (71% female) and 64.9 years (50% female) in the non-RA cohort. The vast majority (>98%) of both cohorts had preserved ejection fraction (EF≥50%). Diastolic dysfunction was more common in RA subjects at 31% compared to 26% (age and sex adjusted) in non-RA subjects (OR 1.6; 95% CI 1.2, 2.4). RA subjects had significantly lower LV mass, higher pulmonary arterial pressure, and higher left atrial volume index than non-RA subjects. RA duration and IL-6 level were independently associated with diastolic dysfunction in RA even after adjustment for cardiovascular risk factors. Conclusion Subjects with RA have a higher prevalence of diastolic dysfunction than those without RA. RA duration and IL-6 are independently associated with diastolic dysfunction suggesting the impact of chronic autoimmune inflammation on myocardial function in RA. Clinical implications of these findings require further investigation.

Background Cross sectional studies suggest that left ventricular (LV) and arterial elastance (stiffness) increase with age, but data examining longitudinal changes within human subjects are lacking. Additionally it remains unknown whether age-related LV stiffening is merely a reaction to arterial stiffening or caused by other processes. Methods and Results Comprehensive echo-Doppler cardiography was performed in 1402 subjects participating in a randomly-selected community-based study at two examinations separated by 4 years. From this population, 788 subjects had adequate paired data to determine LV end-systolic elastance (Ees), end-diastolic elastance (Eed) and effective arterial elastance (Ea). Over 4 years, blood pressure, Ea and LV mass decreased, coupled with significantly greater use of antihypertensive medications. However, despite reductions in arterial load, Ees increased by 14% (2.10±0.67 to 2.26±0.70 mmHg/ml, p<0.0001) and Eed increased by 8% (0.13±0.03 to 0.14±0.04 mmHg/ml, p<0.0001). Increases in Eed were greater in women than men, whereas Ees changes were similar. Age-related increases in Ees and Eed were correlated with changes in body weight, but were similar in subjects with or without cardiovascular disease. Changes in Ees were correlated with Eed (r=0.5, p<0.0001), but not with other measures of contractility, indicating that the increase in Ees was reflective of passive stiffening rather than enhanced systolic function. Conclusions Despite reductions in arterial load with medical therapy, LV systolic and diastolic stiffness increase over time in humans, particularly in women. In addition to blood pressure control, therapies targeting load-independent ventricular stiffening may be effective to treat and prevent age-associated cardiovascular diseases such as heart failure.

The outcome after normal exercise echocardiography is excellent. Subgroups with an intermediate or high pretest probability of having coronary artery disease also have a favorable prognosis after a normal exercise echocardiogram. Characteristics predictive of subsequent cardiac events (i.e., patient age, work load, angina during exercise testing and echocardiographic left ventricular hypertrophy) should be considered in the clinical interpretation of a normal exercise echocardiogram.