Prevalence and Predictors of Diastolic Dysfunction According to Different Classification Criteria

Abstract

Heart failure with preserved ejection fraction is often preceded by diastolic dysfunction (DD). Of several published DD criteria, it is unclear which, if any, are applicable to data obtained in epidemiologic cohorts. We evaluated the prevalence of DD using previously published definitions in a population-based study, the Coronary Artery Risk Development in Young Adults (CARDIA) Study, using data gathered in 2010-2011. Echocardiography was performed on 3,474 individuals (mean age = 50.2 years) at the CARDIA year 25 examination. Four published definitions of DD were studied. We calculated DD prevalence for each definition and determined the overlap between definitions. We used logistic regression to assess the strength of associations between demographic and clinical factors and the definitions of DD. Prevalence of DD ranged from 2% to 32% across the 4 definitions, with a minority of cases identified by more than 1 definition. Two definitions classified 38%-39% of the study sample as indeterminate for DD. Associations of risk factors with DD varied considerably, with male sex being associated positively with DD for one definition (odds ratio = 1.4, 95% confidence interval: 1.2, 1.6) and inversely for another (odds ratio = 0.7, 95% confidence interval: 0.6, 0.8). Prevalence of DD varies markedly in CARDIA by the definition applied. A uniform, reliable, and accurate definition of DD for epidemiologic studies is needed.

Echocardiographic evaluation of diastolic function in the setting of pulmonary hypertension

“…49 Epidemiologic studies have also highlighted the significant differences in prevalence of diastolic dysfunction various population cohorts between prior and current guidelines (Table 2), with variation in the prevalence of diastolic dysfunction up to 30% between different guidelines and a significant proportion still being labeled as ''indeterminant'' based on guidelines. 50,51 The ability of the guidelines to accurately distinguish normal vs abnormal left sided filling pressures has shown mixed results. While some studies have suggested high degree of correlation between non-invasive and invasive measures of left sided filling pressures in patients, 13,[52][53][54] other studies have suggested a modest correlation at best.…”

Rasmussen-Torvik et al. Respond to “The Perfect Measure of Diastolic Dysfunction”

“…We thank Drs. Pandey and Berry for providing insightful commentary (1) on our study (2), which demonstrated poor overlap among currently used definitions of diastolic dysfunction (DD) in a middle-aged cohort. Pandey and Berry caution against a strategy of trying to find "perfect" echocardiographic criteria for DD and urge that investigators consider the incorporation of blood-based markers and exercise capacity into the definition of DD (1), as these markers can help place echocardiographic measurements into proper context from a clinical point of view.…”

Clinical Features Associated With Nascent Left Ventricular Diastolic Dysfunction in a Population Aged 40 to 55 Years

“…Echocardiographic criteria for grading diastolic function evolved over the course of the study period (1997–2014). 22 Thus, our approach of accepting the grade assigned by the interpreting cardiologist reflects their integration of the available data and reflects standards of clinical practice at the time the echocardiograms were interpreted. However, interobserver variability is a potential source of bias in analyses examining individuals with repeated TTE assessments.…”