Impact of Progression of Diastolic Dysfunction on Mortality in Patients With Normal Ejection Fraction

AlJaroudi, Wael; Alraies, M. Chadi; Halley, Carmel; Rodriguez, L. Leonardo; Grimm, Richard A.; Thomas, James D.; Jaber, Wael A.

doi:10.1161/circulationaha.111.066423

Cited by 204 publications

(148 citation statements)

References 19 publications

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“…[17][18][19][20] Since established systolic heart failure drug management revealed rather disappointing benefits in diastolic heart failure, it is important to investigate whether LVDD is potentially reversible by weight reduction, and to understand the mechanisms by which obesity interacts with LVDD. Our prospective weight loss study reports the following findings: first, in agreement to earlier reports, [21][22][23][24][25][26] severe obesity is related to several parameters of diastolic function.…”

Section: Discussionmentioning

confidence: 99%

Successful Weight Reduction Improves Left Ventricular Diastolic Function and Physical Performance in Severe Obesity

et al. 2015

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SummaryObesity and the metabolic syndrome (MetS) are risk factors for left ventricular diastolic dysfunction (LVDD). However, little is known about the impact of successful weight reduction (WR) on diastolic function and physical performance.Obese subjects (øBMI 40.2 ± 8.6 kg/m 2 ) underwent a 1-year WR program comprising diet and lifestyle components. Echocardiography and exercise capacity (6-minute walk) were performed at baseline and after 1 year. The distribution of weight reduction was split at the sample median and subjects were dichotomized in "successful WR" (% WR ≥ median, corresponding to a weight loss of 8%) and "failed-WR" (% WR < median).From a total of 188 obese subjects, 71 had LVDD at baseline. Obese patients with successful WR improved their MetS alterations, including fasting glucose, insulin, lipids, adipokines, blood pressure levels, and epicardial fat thickness. (-28 [-54, -4], P < 0.01), and 6-minute walk distance (65 [19, 135], P < 0.01). Improvement of ≥ 2 LVDD criteria was accomplished in 30% of subjects with WR versus 10% without (P = 0.009). Using multivariable regression analysis, reduction of epicardial fat thickness was particularly predictive for the improvement of diastolic function.In summary, in severe obesity, successful long-term WR was associated with improved LV diastolic function and exercise capacity. (Int Heart J 2015; 56: 196-202) Key words: Adiposity, Metabolic syndrome, Diastolic dysfunction, Weight loss O besity and metabolic syndrome (MetS) are increasing in global prevalence. Accompanying these trends there is a concerning shift in the population weight distribution toward the more extreme ends of obesity, given an increased risk for cardiovascular morbidity and mortality that is associated with excess adiposity.1-4) One associated finding is an impairment of cardiac performance leading to myocardial systolic and diastolic dysfunction and clinical symptoms often indistinguishable from heart failure. In fact, evidence of left ventricular diastolic dysfunction (LVDD) is a common finding in the obese, and consequently, obesity is considered a risk factor for diastolic heart failure. 5-9)Although lifestyle modification and weight reduction are routinely recommended to improve symptoms and to reduce cardiovascular risk in the obese with metabolic disorders, their effects on diastolic function and physical performance have been studied only rudimentarily, particularly in adults with severe obesity. Thus, the aim of the present study was to assess the effect of long-term lifestyle and weight reduction programs on these measures in severely obese subjects with varying degrees of MetS.Notably, there is considerable variation in biological determinants, encompassing metabolic and endocrine factors and in the degree of weight loss per se achieved by individuals in response to caloric restriction and physical activity. 10,11) In this regard, it is of interest that several of these biological determinants may independently influence diastolic function or modify the effect of...

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Section: Discussionmentioning

confidence: 99%

Successful Weight Reduction Improves Left Ventricular Diastolic Function and Physical Performance in Severe Obesity

et al. 2015

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“…Systemic hypertension has been associated with many long term complications including systolic and diastolic heart failure, stroke, and myocardial infarction (10)(11)(12). Diastolic dysfunction associated with hypertension, especially of the left ventricle, has been linked with increasing mortality and morbidity (13,14). Diastolic heart failure (or heart failure with preserved ejection fraction) has been reported to have a higher risk and worse prognosis than heart failure with reduced ejection fraction (13,15).…”

Section: Discussionmentioning

confidence: 99%

Carotid atherosclerosis and right ventricular diastolic dysfunction in a sample of hypertensive Nigerian patients

Akintunde¹,

Adebayo

Aremu

et al. 2013

Croat Med J

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AimTo determine the association of carotid atherosclerosis and right ventricular diastolic dysfunction (DD) among treated hypertensive Nigerian patients. MethodsThis was a single center cross-sectional study performed at the Cardiology Clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria between January and December 2012. The study included 122 hypertensive Nigerians (mean age, 57.3 ± 14.7 years, 36.9% women). Patients' clinical, demographic, and echocardiographic parameters were obtained. Diastolic dysfunction was assessed with the trans-tricuspid Doppler flow.Results Patients with DD were significantly older than those with normal diastolic function. Mean and maximum carotid intima media thickness measurements were significantly higher among patients with right ventricular DD than in those with normal diastolic function. Mean systolic blood pressure (148.3 ± 31.9 vs 128.0 ± 2.8 mm Hg, P = 0.049) and interventricular septal thickness in diastole (12.8 ± 2.3 vs 11.6 ± 2.8 mm, P = 0.048) were significantly higher and tricuspid annular pulmonary systolic excursion (33.6 ± 4.9 vs 23.0 ± 4.2 mm, P = 0.035) was significantly lower in patients with right ventricular DD than in those with normal diastolic function. Carotid intima media thickness measurements were correlated with early trans-tricuspid Doppler flow and early transtricuspid diastolic flow/late right atrial transtricupsid diastolic flow ratio.Conclusion Right ventricular DD in hypertensive patients was significantly correlated with increased carotid atherosclerosis. Carotid intima media thickness measurements may therefore be a surrogate marker for DD in hypertensive subjects.

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“…To our knowledge, 2 community-based studies 9,10 explored the factors predictive of the development of subclinical LV diastolic dysfunction. In the clinical setting, Aljaroudi et al 11 reported that in patients with normal baseline LV ejection fraction, worsening of diastolic function grade was an independent predictor of mortality. However, serial imaging studies are also needed to clarify the clinical correlates of change in LVDF indexes.…”

Section: See Editorial By Fitzgibbons and Aurigemma See Clinical Persmentioning

confidence: 99%

Longitudinal Changes in Left Ventricular Diastolic Function in a General Population

Kuznetsova

Thijs

Knez

et al. 2015

Circ: Cardiovascular Imaging

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Because life expectancy and the prevalence of risk factors, such as hypertension, obesity, insulin resistance and diabetes mellitus are rising globally, heart failure is growing into a major health problem. Impairment of left ventricular diastolic function (LVDF) appears early in the course of heart disease. Recent heart failure guidelines, therefore, place special emphasis on the detection of subclinical LV dysfunction and the timely identification of risk factors for progression to symptomatic heart failure.1 Conventional echocardiography combined with new imaging techniques such as tissue Doppler imaging (TDI) is a sensitive tool to detect early subclinical deterioration of LV function.2 Recent community-based studies revealed a higher than hitherto expected prevalence of LV diastolic dysfunction, using comprehensive conventional and TDI echocardiographic imaging. [3][4][5][6] For instance, in the Flemish Study on Environment, Genes, and Health Outcomes (FLEMENGHO), the frequency was 27.3%.5 LV diastolic dysfunction is also associated with increased risk for various cardiovascular diseases. 4,7,8 See Editorial by Fitzgibbons and Aurigemma See Clinical PerspectiveCommunity-based studies have identified cross-sectionally that age, body mass index, heart rate (HR), and diastolic blood pressure (DBP) are important correlates of echocardiographic LVDF indexes. 5,6 However, data on the longitudinal tracking of LVDF over time are sparse. To our knowledge, 2 community-based studies 9,10 explored the factors predictive of the development of subclinical LV diastolic dysfunction. In the clinical setting, Aljaroudi et al 11 reported that in patients with normal baseline LV ejection fraction, worsening of diastolic function grade was an independent predictor of mortality. However, serial imaging studies are also needed to clarify the clinical correlates of change in LVDF indexes. These data are currently lacking. We, therefore, investigated Background-Data on changes in left ventricular diastolic function (LVDF) over time in the general population are sparse.We, therefore, investigated in the population cohort clinical correlates of longitudinal changes in Doppler diastolic indexes analyzed as continuous measures and assessed factors predictive of the changes in LVDF grades over time. Methods and Results-We measured early and late diastolic peak velocities of mitral inflow (E and A) by conventional Doppler, and the mitral annular velocities (e′ and a′) by tissue Doppler imaging in 650 participants (mean age, 50.7 years) at baseline and after 4.7 years (5th to 95th percentile, 3.7-5.4). In stepwise regression, the multivariable-adjusted correlates of the change in the transmitral and tissue Doppler imaging diastolic indexes included sex, age, baseline serum insulin, blood pressure, and heart rate. During follow-up, LVDF grades remained unchanged in 87.2% (95% confidence interval, 84.6%-89.8%), improved in 3.7% (95% confidence interval, 2.25%-5.15%), and worsened in 9.1% (95% confidence interval, 6.9%-11.3%). Baseline age ...

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Impact of Progression of Diastolic Dysfunction on Mortality in Patients With Normal Ejection Fraction

Abstract: Background-Diastolic dysfunction is an independent predictor of mortality in patients with normal left ventricular ejection fraction. There are limited data, however, on whether worsening of diastolic function is associated with worse prognosis.

Cited by 204 publications

References 19 publications

Successful Weight Reduction Improves Left Ventricular Diastolic Function and Physical Performance in Severe Obesity

Successful Weight Reduction Improves Left Ventricular Diastolic Function and Physical Performance in Severe Obesity

Carotid atherosclerosis and right ventricular diastolic dysfunction in a sample of hypertensive Nigerian patients

Longitudinal Changes in Left Ventricular Diastolic Function in a General Population

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