Diastolic dysfunction in individuals with and without heart failure with preserved ejection fraction

Jan-Per Wenzel,Stefan Blankenberg,Christina Magnussen,Benedikt Schrage,Ramona Bei Der Kellen,Renate Schnabel,Julius Nikorowitsch

doi:10.1007/s00392-021-01907-x

Jan-Per Wenzel, Stefan Blankenberg + Show 5 more

Open Access

https://doi.org/10.1007/s00392-021-01907-x

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Abstract

AimLeft ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population.Methods and resultsFrom the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD.ConclusionThe prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.

Highlights

Heart failure (HF) with preserved ejection fraction (HFpEF) is a widespread syndrome with increasing prevalence
75 (1.3%) subjects suffered from heart failure with preserved ejection faction (HFpEF) (DDwHFpEF) and 678 (11.5%) participants were asymptomatic (ALVDD)
The prevalence of most cardiovascular risk factors gradually increased from normal diastolic function to Asymptomatic left ventricular diastolic dysfunction (ALVDD) to DDwHFpEF, including arterial hypertension, diabetes, current smoking, coronary artery disease (CAD), 1 3

Summary

Introduction

Heart failure (HF) with preserved ejection fraction (HFpEF) is a widespread syndrome with increasing prevalence. It is characterized by clinical symptoms or signs, left ventricular ejection fraction ≥ 50%, and a pathological increase of cardiac filling pressures. Diastolic dysfunction (DD) plays a key role in the genesis of HFpEF [3] It describes the successive disability of the left ventricle to properly relax during diastole, leading to an increase of left ventricular end-diastolic pressure. The formation of ALVDD as well as its transition to HFpEF might be driven by risk factors and comorbidities such as age, diabetes, elevated blood pressure, and bodymass [8]. There is little evidence from population-based data on factors differentiating ALVDD from DD with HFpEF (DDwHFpEF)

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