Prognostic Value of Diastolic Dysfunction

AlJaroudi, Wael; Thomas, James D.; Rodriguez, L. Leonardo; Jaber, Wael A.

doi:10.1097/crd.0b013e31829cf733

Cited by 43 publications

(33 citation statements)

References 110 publications

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“…Based upon current literature, diastolic dysfunction appears to represent an early marker of subclinical cardiovascular disease [5, 15]. There is increasing evidence demonstrating the independent predictive value of diastolic dysfunction [15].…”

Section: Discussionmentioning

confidence: 99%

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Progression of Left Ventricular Diastolic Dysfunction in Ethnic Minorities

Prendergast

Dudley

Kane

et al. 2013

High Blood Press Cardiovasc Prev

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Background Approximately 50 % of heart failure cases are due to diastolic failure. Generally, it is thought that asymptomatic diastolic dysfunction precedes the development of diastolic heart failure, representing an ideal time for intervention. Previous studies have examined progression rates in non-minority populations only. Objective To determine the rate of diastolic dysfunction progression and the associated risk factors in a predominately ethnic minority population. Design, Setting, and Participants A retrospective cohort study of participants drawn from the echocardiogram database and Electronic Health Record (EHR) for an academic medical center. Individuals with 2 or more echo-cardiograms showing diastolic dysfunction during a six-year study period (2006–2012) were selected. Main Outcome Measures Change in diastolic function grade over time and risk factors associated with this change. Results During the six-year retrospective study period, 154 patients with 2 or more echocardiograms demonstrating diastolic dysfunction were reviewed; these represented 496 echocardiograms. The mean time between echocardiograms was 1.9 years. Mean age was 64.6 (±10.1) years, 81 % were female, and average BMI was 30.5(±7.4). The majority of subjects had Grade I diastolic dysfunction at the initial examination (87.7 % (n = 135)); 9 % (n = 14) had Grade II, and 3 % (n = 5) had Grade III. Approximately 27.9 % (n = 43) of the study cohort demonstrated overall worsening grade of diastolic dysfunction over time. Diastolic dysfunction grade was unchanged in 62 % (n = 96), improved in 9.7 % (n = 14), and worsened then improved in 0.7 % (n = 1). Conclusions Our study showed a slightly higher rate of diastolic dysfunction progression in this predominately ethnic minority population. This is consistent with a previous study in a non-minority population demonstrating the progressive nature of diastolic dysfunction over time. Understanding the role of cardiovascular disease risk factors in accelerating progression rates from asymptomatic diastolic dysfunction to symptomatic stages is paramount to optimize intervention strategies.

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Section: Discussionmentioning

confidence: 99%

“…There is increasing evidence demonstrating the independent predictive value of diastolic dysfunction [15]. Further studies should replicate this in other minority populations and then prospectively study whether any of these risk factors can be modified and if so does that slow the progression of diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Progression of Left Ventricular Diastolic Dysfunction in Ethnic Minorities

Prendergast

Dudley

Kane

et al. 2013

High Blood Press Cardiovasc Prev

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“…Studies have estimated the prevalence of subclinical diastolic dysfunction can be as high as 48% among high-risk groups with cardiovascular risk factors. 7,8 Levy et al in a cohort of African American patients identified from an urban ED found a 90% point prevalence of subclinical hypertensive heart disease. 9 Left ventricular hypertrophy (LVH) is one of the strongest predictors of adverse cardiovascular outcomes in a hypertension population.…”

Section: Introductionmentioning

confidence: 99%

Correlation between Subclinical Heart Disease and Cardiovascular Risk Profiles in an Urban Emergency Department Population with Elevated Blood Pressures: A Pilot Study

Prendergast

Colla

Patel

et al. 2015

The Journal of Emergency Medicine

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Objective Determine the point prevalence of left ventricular hypertrophy and diastolic dysfunction in an urban emergency department (ED) population with elevated blood pressures (EBP) and examine the correlation between subclinical disease and patient cardiovascular risk profiles. Methods A convenience sample of emergency department patients with elevated blood pressures (blood pressure ≥ 140/90 mm Hg on at least 2 measurements) with or without a history of hypertension were enrolled. Subjects had limited bedside echocardiograms performed by ED physicians with ultrasound training and baseline laboratory studies obtained. Patients were classified as having subclinical hypertensive heart disease if any of the following were identified using standard echocardiogram criterion: left ventricular hypertrophy, abnormal ejection fraction, or diastolic dysfunction. Results A total of 39 patients with EBP were enrolled. The mean age was 46 years (SD 10.9 years), 59 % (n=23) were women, 21% (n=8) were smokers, and 92% had a history of hypertension (n=33). The average BMI was 30.7 (SD=8.7). Racial/ethnicity included African Americans 67% (n=26), Latinos 23% (n=9), Caucasian 5% (n=2), Asian and Native Americans 3% (n=1 respectively). Subclinical hypertensive disease was found in 39% (n=15) with 31% (n=12) having left ventricular hypertrophy, 15% (n=6) having evidence of diastolic dysfunction and 8% (n=3) having abnormal ejection fraction. On bivariate analysis elevated diastolic blood pressure (p=0.039) and blood urea nitrogen (p=0.016) were correlated with the presence of subclinical heart disease. After adjusting for other covariates, receiving oral/intravenous antihypertensive medications in the ED (p= 0.005) was associated with subclinical heart disease in multivariate regression analysis. Conclusions We found a point prevalence of subclinical heart disease of 39% in this urban ED population with EBP screened using limited bedside echocardiograms performed by ED physicians. Identification of subclinical heart disease at early stages in real-time in the ED in conjunction with abnormal renal function can help ED physicians risk stratify and identify those patients in need of more aggressive therapy and urgent follow-up thus decreasing the likelihood of cardiovascular disease progression and complications such as heart failure and renal failure at later stages.

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“…Left ventricular diastolic dysfunction (LVDD) is recognized as an important contributor to diastolic heart failure and is associated with increased morbidity and mortality (1). Hypertension and cardiac ischemia are the most common causes of diastolic heart failure (2).…”

Section: Introductionmentioning

confidence: 99%

The impact of hypertension on diastolic left ventricular function, evaluated by quantitative ECG-gated myocardial perfusion SPECT

Sayed

El-Tayeb²,

Farghaly

2015

The Egyptian Journal of Radiology and Nuclear Medicine

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Background: Abnormality of left ventricular (LV) diastolic function is frequently the earliest indicator of LV dysfunction in many diseases, including coronary artery disease (CAD), and hypertension. Electrocardiography (ECG)-gated technetium (Tc)-99 m tetrofosmin singlephoton emission computed tomography (SPECT) has been reported to be a useful method for evaluation of LV function. Objectives: The purpose of this study was to assess the impact of hypertension on diastolic left ventricular function using ECG-gated Tc-99m tetrofosmin SPECT. Methods: Thirty consecutive patients with normal exercise myocardial perfusion and normal LV systolic function, were studied out of 233 patients underwent ECG-gated Tc-99m tetrofosmin SPECT at our institution between January 2012 and December 2013. Patients were divided into two groups according to the presence or absence of systemic hypertension (blood pressure P140/ 90 mm Hg on P3 measurements or treatment with antihypertensive medication). Parameters of diastolic LV function were assessed. Results: Of the studied 30 patients, 19/30 (63%) had hypertension. There was no difference with respect to age, gender, LV end-diastolic volume (EDV), LV end-systolic volume (ESV), and LV ejection fraction values obtained by quantitative gated SPECT between patients with and without hypertension. The first-third mean filling rate (1/3 MFR), peak filling rate (PFR) of patients with hypertension (1.22 ± 0.38, 2.83 ± 1.10 EDV/s) were lower than those of patients without This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). hypertension (1.54 ± 0.30, 2.90 ± 0.35 EDV/s), and the time to peak filling (TTPF) of patients with hypertension (199.42 ± 68.34 ms) was higher than TTPF of patients without hypertension (164.90 ± 36.39 ms). Conclusions: Quantitative ECG-gated Tc-99m tetrofosmin SPECT reveals that hypertensive patients with preserved global LV systolic function may have significant changes in diastolic LV function. Gated myocardial perfusion SPECT reports are always lacking in these changes in diastolic function. We recommend inclusion of such changes in diastolic function in gated myocardial perfusion SPECT reports that can help in proper management of hypertensive patients.

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Prognostic Value of Diastolic Dysfunction

Cited by 43 publications

References 110 publications

Progression of Left Ventricular Diastolic Dysfunction in Ethnic Minorities

Progression of Left Ventricular Diastolic Dysfunction in Ethnic Minorities

Correlation between Subclinical Heart Disease and Cardiovascular Risk Profiles in an Urban Emergency Department Population with Elevated Blood Pressures: A Pilot Study

The impact of hypertension on diastolic left ventricular function, evaluated by quantitative ECG-gated myocardial perfusion SPECT

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