Prevalence of left ventricular diastolic dysfunction in European populations based on cross-validated diagnostic thresholds

Abstract

BackgroundDifferent diagnostic criteria limit comparisons between populations in the prevalence of diastolic left ventricular (LV) dysfunction. We aimed to compare across populations age-specific echocardiographic criteria for diastolic LV dysfunction as well as their correlates and prevalence.MethodsWe measured the E and A peaks of transmitral blood flow by pulsed wave Doppler and the e' and a' peaks of mitral annular velocities by tissue Doppler imaging (TDI) in 2 cohorts randomly recruited in Belgium (n = 782; 51.4% women; mean age, 51.1 years) and in Italy, Poland and Russia (n = 476; 55.7%; 44.5 years).ResultsIn stepwise regression, the multivariable-adjusted correlates of the transmitral and TDI diastolic indexes were similar in the 2 cohorts and included sex, age, body mass index, blood pressure and heart rate. Similarly, cut-off limits for the E/A ratio (2.5th percentile) and E/e' ratio (97.5th percentile) in 338 and 185 reference subjects free from cardiovascular risk factors respectively selected from both cohorts were consistent within 0.02 and 0.26 units (median across 5 age groups). The rounded 2.5th percentile of the E/A ratio decreased by ~0.10 per age decade in these apparently healthy subjects. The reference subsample provided age-specific cut-off limits for normal E/A and E/e' ratios. In the 2 cohorts combined, diastolic dysfunction groups 1 (impaired relaxation), 2 (possible elevated LV filling pressure) and 3 (elevated E/e' and abnormally low E/A) encompassed 114 (9.1%), 135 (10.7%), and 40 (3.2%) subjects, respectively.ConclusionsThe age-specific criteria for diastolic LV dysfunction were highly consistent across the study populations with an age-standardized prevalence of 22.4% vs. 25.1%.

Conventional and Ambulatory Blood Pressure as Predictors of Diastolic Left Ventricular Function in a Flemish Population

“…The clinical implications of our current findings can be gauged against the prognosis associated with asymptomatic diastolic LV dysfunction, which in the general population has a prevalence of around 25%4, 5 and over time evolves to symptomatic LV dysfunction6 and heart failure2 and predicts the incidence of adverse health outcomes. Guideline‐driven echocardiographic criteria24, 25 to stage patients with advanced diastolic LV dysfunction leave a large proportion of people unclassified in population studies.…”

“…Subclinical diastolic left ventricular (LV) dysfunction has a prevalence of 25% in the general population,4, 5 predisposes to further deterioration of LV function,6 and finally evolves to overt HF 2. Raised blood pressure is the major risk factor associated cross‐sectionally4, 5, 7 and prospectively6, 8, 9, 10 with diastolic LV dysfunction in the general population. Most studies making this point relied on conventional office blood pressure.…”

1.1 Diastolic Left Ventricular Function in Relation to Circulating Metabolic Biomarkers in a General Population

“…In the next step of our analyses, we dichotomized the study population in 538 participants with normal LV function and in 173 with subclinical diastolic LV dysfunction 4,5 and used a binary dummy variable indicating membership to these 2 groups as a dependent variable in a partial least squares discriminant analysis (PLS-DA) to identify a set of independent latent factors (LFs) that were linear combinations of the metabolites and that maximized the covariance between the metabolites and LV diastolic dysfunction. We retained the smallest number of latent factors for which the predicted residual sums of squares (PRESS; calculated using leave-one-out cross-validation) did not differ significantly (P>0.10) from the model with the minimum PRESS value as assessed by the van der Voet T 2 statistic.…”

“…15 We dichotomized diastolic LV function into normal and abnormal as described in previous publications. 4,5 Diastolic dysfunction included: (1) patients with an abnormally low agespecific transmitral E/A ratio indicative of impaired relaxation, but without evidence of increased LV filling pressures (E/e' ≤8.5); (2) patients with mildly to moderately elevated LV filling pressure (E/e' >8.5) and an E/A ratio within the normal age-specific range; and (3) and patients with an elevated E/e' Diastolic dysfunction includes an abnormally low age-specific transmitral E/A ratio without increased LV filling pressures (E/e' ≤8.5) or an elevated LV filling pressure (E/e' >8.5) with normal or low age-specific E/A (see references 4 and 5). By definition, all P values for the between-group differences were significant.…”

“…4,5 The PLS-DA procedure identified 3 latent factors accounting for 19.5%, 21.3%, and 13.6% of the variance in the metabolites and 54.4% in total. Table 7 presents the factor loadings of the circulating metabolites on LF1, LF2, and LF3.…”