Exploring the Role and Mechanism of DSF in HFpEF Based on IL-1β/IL-1βR/TAK1/RIPK1 Axis-Mediated PANoptosis.

Objective This research investigated the application of real-time, three-dimensional speckle tracking imaging (RT-3D-STI) to evaluate left atrial (LA) function in individuals suffering from hypertensive heart disease (HHD) and heart failure with preserved ejection fraction (HFpEF).Material and methods This retrospective study included 100 patients with HHD and HFpEF hospitalized from August 2023to June 2024 (HFpEF group). 100 healthy individuals undergoing physical examinations comprised the control group. Patient data were collected, and echocardiography was performed to measure LA diameter (LAD), left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular outflow tract diameter (LVOTd), early diastolic maximum velocity of mitral valve inflow (MVE), late diastolic maximum velocity of mitral valve inflow (MVA), early diastolic and late diastolic velocities of mitral annulus measured by tissue Doppler ultrasound (e' and a'), tricuspid annular plane systolic excursion (TAPSE), and left ventricular ejection fraction (LVEF). The LA images were analyzed using GE software, and the following parameters were measured: L emptying fraction (LAEF), LA emptying volume (LAEV), LAvolume at the onset of contraction (LAVpreA), minimum LA volume (LAVmin), maximum LA volume (LAVmax), LA strain during the reservoir phase (LASr), LA strain during the contraction phase (LASct), and LA strain during the conduit phase (LAScd). ROC curves were adopted to evaluate the diagnostic value of LA parameters for HFpEF, and a Pearson correlation analysis examined the relationship between these parameters and N-terminal pro-B-type natriuretic peptide (NT-proBNP).Results Compared with the control group, the blood pressure in the HFpEF group was significantly higher (p<0.05). In the HFpEF group, NT-proBNP concentrations were significantly greater than those observed in the control group (p<0.05). No statistically significant variances were detected in LVEF, LVEDD, LVOTd, TAPSE, MVE, MVA, ratio of E wave velocity to A wave velocity (E / A), a', LAEV, LAVmin, or LAVpreA between the two groups (p>0.05). Compared to the control group, the HFpEF group had dramatically higher LAD, IVST, and LVPWT (p<0.05). The HFpEF group also had lower e', LAEF, LASr, LAScd, and LASct, while E / e', maximum LA volume index (LAV Imax), and LAVmax were higher (p<0.05). LASr was negatively associated with NT-proBNP (r=-0.255, p=0.016), whereas no significant correlation was found among LAScd, LASct, and NT-proBNP (P>0.05).Conclusion LA strain parameters can serve as a non-invasive method for quantitatively assessing LA dysfunction in patients with HFpEF.

Left Atrial Reservoir Strain: A Savior to Diastolic Function Assessment in Hypertrophic Cardiomyopathy?

Effect of If-Channel Inhibition on Hemodynamic Status and Exercise Tolerance in Heart Failure With Preserved Ejection Fraction: A Randomized Trial

A standard 12-lead electrocardiogram (ECG) is performed in all hypertensive patients, primarily to detect left ventricular hypertrophy. Echocardiographic assessment of hypertensive subjects reveals that abnormalities in diastolic function occur more commonly and earlier than increased left ventricular mass. However, ECG changes associated with diastolic dysfunction (DD) remain poorly defined; we assessed the ventricular activation time (VAT) (i.e., the time for the ventricle to depolarize) as a potential marker for DD in early hypertension. Ninety subjects (aged 46 +/- 1.3 years; 43 men) with newly diagnosed, untreated hypertension underwent ECG and comprehensive two-dimensional echocardiography. Left ventricular DD was echocardiographically assessed using Canadian Consensus Guidelines. We compared VAT, which corresponds to the QR interval in the 12-lead ECG, with echocardiographic parameters of DD. VAT was prolonged in subjects with DD (46.3 +/- 0.4 vs. 39.6 +/- 0.3 ms, P < 0.01). There was a significant correlation between VAT and tissue Doppler imaging (TDI) (early diastolic velocity) e' (r = -0.53, P < 0.0001), (ratio of early and late diastolic velocities) e'/a' (r = -0.53, P < 0.0001), transmitral Doppler (TMD) (early peak filling rate, and early deceleration peak) E/A (r = -0.32, P = 0.001), and (ratio of early diastolic mitral inflow and early diastolic velocities) E/e' (r = 0.44, P < 0.0001). Prolongation of the VAT is associated with DD in patients with newly diagnosed untreated hypertension.

Aim. To evaluate the relationship between the level of galectin-3 (Gal-3) and left ventricular (LV) structural and functional characteristics in coronary artery disease (CAD) with NYHA class I-III heart failure (HF) with and without type 2 diabetes (T2D) and chronic kidney disease (CKD).Material and methods. We examined 120 patients (men — 68,3%) with coronary artery disease and class I-III HF, divided into 3 groups: group 1 — patients without T2D and CKD (n=40), group 2 — with CKD without T2D (n=40), group 3 — with T2D and CKD (n=40). The Gal-3 level was determined using the enzyme immunoassay, and LV global longitudinal strain (GLS) was determined using the speckle tracking method.Results. In patients with coronary artery disease and CKD, including T2D, Gal-3 was higher (p=0,048) (in group 1 — 12,55 [10,60;23,05], in group 2 — 16,60 [11,75;23,95], in group 3 — 16,90 [11,90;25,15] ng/ ml) and more closely correlated with volume parameters, LV ejection fraction and the ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e'). Grade 2 diastolic dysfunction (DD) in group 1 was in 10%, in group 2 — in 47,5%, in group 3 — in 60% of patients. The groups did not differ in GLS (p=0,087).Conclusion. An increase in Gal-3 concentration with worsening HF and correlations between the biomarker level and volume parameters, LV mass index, LV ejection fraction, GLS and diastolic dysfunction indicate its important role in the development of myocardial remodeling and fibrosis.

Both patients with heart failure (HF) with reduced ejection fraction (HFrEF) and those with HF with preserved ejection fraction (HFpEF) present with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) and have multiple comorbidities; consequently, the prognostic effect of NT-proBNP according to beta-blocker (BB) use is unknown. This retrospective study evaluated patients admitted for acute HF between January 2012 and December 2017 at Ulsan University Hospital. Clinical, echocardiographic, laboratory and drug prescription data, including BB data, were collected from the hospital database. Information on mortality was collected by reviewing medical records or using national death data. Of the 472 patients evaluated, 216 (45.8%) and 256 (54.2%) patients were and were not prescribed BB at discharge, respectively. A total of 224 (47.5%) patients died within a median follow-up duration of 44months. The Kaplan-Meier analysis showed reduced all-cause mortality with BB in HFrEF (ejection fraction≤40%) but not in HFpEF (ejection fraction>40%). In the multivariate Cox regression analysis, transmitral to tissue Doppler imaging, early diastolic velocity ratio (E/E'), NT-proBNP and BB use were independent predictors of all-cause mortality in HFrEF. Meanwhile, haemoglobin and NT-proBNP levels were independent predictors of HFpEF. The NT-proBNP cut-off value for determining all-cause mortality was set to 4800pg/mL. Among HFrEF patients with NT-proBNP<4800pg/mL, the survival rate was higher for patients with BB use than those with no BB use (log-rank P<0.001). However, in the HFpEF group, the survival rate associated with BB use did not differ according to the NT-proBNP levels. Both HFrEF and HFpEF patients with NT-proBNP levels of ≥4800pg/mL presented with multiple comorbidities, including lower body mass index and haemoglobin levels and higher creatinine levels, NT-proBNP levels and E/E'. In patients with acute HF, BB use is associated with reduced all-cause mortality in those with HFrEF but not in those with HFpEF. HFrEF patients with NT-proBNP levels of <4800pg/mL treated with BB have a higher survival rate than those not treated with BB. However, this benefit is not seen in HFrEF patients with NT-proBNP levels of ≥4800pg/mL or in all HFpEF patients, regardless of the NT-proBNP level. NT-proBNP levels are elevated in multiple comorbid conditions, and these comorbidities may contribute to the attenuated effects of BB on all-cause mortality.

Introduction: Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and causes substantial morbidity, mortality, and resource utilization in the aging population. The plasma level of B-type natriuretic peptide (BNP) is used as a marker of HF with reduced EF (HFrEF). However, the role of BNP in HFpEF is not well known. The purpose of the present study was to compare the levels of BNP together with the echocardiographic findings between HFpEF and HFrEF. Methods: The study subjects consisted of 1574 patients with HF and early diastolic flow velocity (E)/velocity of early diastolic mitral annular motion (e′) or E/e′≥15 (as a measure of elevated left atrial pressure) (574 men and 1000 women, mean age 78.8±10.7) admitted at our hospital. They were divided into 1238 patients with HFpEF (373 men and 865 women, mean age 79.7±10.2) [left ventricular (LV) EF≥50% and E/e′≥15] and 336 patients with HFrEF (201 men and 135 women, mean age 75.4±11.8) (LVEF&lt;50%). Echocardiographic parameters, age, gender, and BNP were examined. Results: The levels of BNP were lower [107(47, 225) pg/ml vs. 296(121, 626) pg/ml, P&lt;0.001] in the HFpEF group than in the HFrEF group. The frequencies of female gender, age, EF, LV posterior wall thickness were higher (all P&lt;0.001, respectively) and LV mass, LV end-diastolic diameter (LVDd), LV end-systolic diameter (LVDs) and left atrial diameter (LAD) were lower (all P&lt;0.001, respectively) in the HFpEF group than in the HFrEF group. A multiple regression analysis revealed EF (t=-17.0), age (t=11.2), E/e′ (t=10.5), LAD (t=9.0), LV mass (t=7.9), and LVDd (t=-5.3) were independent predictors (all P&lt;0.001, respectively) for the BNP level (P&lt;0.001, R2=0.40) in this order. Conclusions: HFpEF was associated with lower levels of BNP and smaller heart and was more prevalent in the elders and women as compared with HFrEF. Predictors for the levels of BNP were EF, age, and E/e′ in this order. These findings imply that the plasma levels of BNP reflect LVEF more than LV diastolic function (E/e′) and thus are lower in the HFpEF group than in the HFrEF group. These findings suggest that the role of BNP in HF may be different between HFpEF and HFrEF.

To evaluate the usefulness of ratio of early diastolic transmitral flow velocity (E) to mitral annular velocity (e') calculated by simultaneously recording E and e' in coronary heart disease (CHD) patients. A total of 77 CHD patients with preserved systolic functions underwent echocardiography. Left ventricular catheterization was performed to measure left ventricular end diastolic pressure (LVEDP). The accuracy of E/e' was compared by recording the dual-Doppler and conventional methods for diagnosing diastolic dysfunction and the relationships between N-terminal pro-brain natriuretic peptide (NT-proBNP). The validity of E/e'dual Doppler and combined E/e'dual Doppler and NT-proBNP in estimating left ventricular diastolic dysfunction namely LVEDP ≥ 12 mmHg (1 mmHg = 0.133 kPa) were estimated. E/e'dual Doppler was correlated with left ventricular end diastolic pressure (LVEDP) and logNT-proBNP (r = 0.79, r = 0.47, respectively, P < 0.01). E/e'conventional was correlated with LVEDP and logNT-proBNP (r = 0.61, P < 0.01, r = 0.35, P < 0.05, respectively). The area under curve (AUC) of E/e'dual Doppler and E/e'conventional was 0.87 and 0.82. The optimal cut-off of E/e'dual Doppler was 9.2 with a sensitivity of 74% and a specificity of 81%. And the optimal cut-off of plasma NT-proBNP was 108 ng/L with a sensitivity of 69% and a specificity of 86%, AUC 0.79.When E/e'dual Doppler ≥ 9.2 and NT-proBNP ≥ 108 ng/L were combined, the sensitivity and specificity for diagnosing diastolic dysfunction were 86% and 69%, AUC 0.89. The accuracy of E/e'dual Doppler is better than E/e'conventional for diagnosing left diastolic dysfunction. When E/e'dual Doppler and NT-proBNP are combined, it improves the evaluation accuracy of left diastolic dysfunction.

While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n = 187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥ - 16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505 pg/mL (161, 1065) vs. 875 pg/mL (488, 1802), P = 0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7 µg/L (5.1, 8.1) vs. 8.1 µg/L (6.5, 10.5), P = 0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r = 0.29, P < 0.001 and r = 0.19, P = 0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope. Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome.

Optimal Noninvasive Assessment of Diastolic Heart Failure in Patients with Atrial Fibrillation: Comparison of Tissue Doppler Echocardiography, Left Atrium Size, and Brain Natriuretic Peptide

Transthoracic echocardiography plays an important role as an imaging tool for the evaluation of heart failure with preserved ejection fraction (HFpEF). Among the imaging findings, the E/e' ratio, a surrogate for left atrial (LA) filling pressure, is a robust indicator that supports the diagnosis of HFpEF. Other findings such as left ventricular (LV) early diastolic tissue velocity (e'), LA volume, LA strain and LV global longitudinal strain are also related to LA filling pressure, and these parameters are useful for the diagnosis of HFpEF. Although some patients with HFpEF do not have abnormalities in these indices at rest, they may develop abnormalities in LA filling pressure exclusively during exercise.1 Therefore, HFpEF is difficult to diagnose in symptomatic elderly outpatients with limited exercise capacity (Figure 1). There are two types of probability tests in which HFpEF is present in patients with dyspnoea based on the findings obtained in clinical settings: the H2FPEF score2 and the HFA-PEFF score.3 Although both scores included echocardiographic indices, the H2FPEF score focuses on comorbidities, whereas the HFA-PEFF score includes natriuretic peptide levels. Most patients with HFpEF have a history of hypertension, and their blood pressure levels may no longer be elevated by medications at the time of evaluation.4 Furthermore, most patients with HFpEF show a high BMI, which is not the case in older patients.5 Because natriuretic peptide levels are occasionally within normal limits in patients with HFpEF, they may not be necessary for the diagnosis of HFpEF.2 Haemodynamic exercise tests play a key role when one cannot make a definitive decision of developing HFpEF. Noninvasive exercise testing does not discriminate between patients with cardiac and non-cardiac causes of dyspnoea.6 Although exercise echocardiography is a useful tool in place of invasive stress testing, there are contradictory results regarding the significance of the E/e' ratio for LA filling pressure.7, 8 Since LV diastolic function is affected by afterload, we recently evaluated LV diastolic function as a vascular resistance-integrated index: the ratio of LV diastolic elastance (Ed) to arterial elastance (Ea) = (E/e')/(0.9 × systolic blood pressure).9 This noninvasive index shows the ratio of LA filling pressure to LV end-systolic pressure and is a significant index of all-cause mortality in a multivariate Cox proportional hazards regression analysis performed by adjusting for age, comorbidities, natriuretic peptide levels and echocardiographic indices in elderly patients with HFpEF.10, 11 Stress tests cause an elevation of systolic blood pressure, and the extent of the change in blood pressure is different in each patient. Using an index such as Ed/Ea, the conflicting consequences described above may disappear. For the diagnosis of heart failure (HF), patients are aware of certain symptoms such as exertional dyspnoea, chest discomfort and fatigue. However, the symptoms are sometimes obscured in older patients. In clinical settings, it is important to identify patients with latent HFpEF who will likely be admitted for HF treatment in the near future. When populations with asymptomatic hypertension undergo invasive exercise stress or exercise echocardiography, some portions may exhibit an elevated LA filling pressure during exercise. We may call these populations ‘pre-HFpEF’ patients in terms of clinical entity.12 Asymptomatic LV hypertrophy is a potent risk factor for HFpEF.13 The main pathologies of HFpEF include cardiomyocyte remodelling and interstitial collagen deposition resulting from endothelial dysfunction and microvascular inflammatory changes.14-16 These latent populations might have treatment as ‘pre-HFpEF’ to avoid admission for HF. The diagnosis and treatment of asymptomatic elderly outpatients without a history of admission for HF, who possibly show exercise-induced elevation of LA filling pressure, remain to be defined. Recently, emerging differences in the phenotyping of HFpEF have been shown.17, 18 Asymptomatic patients with certain phenotypes must undergo stress echocardiography to diagnose pre-HFpEF. Under these conditions, the measurement of the Ed/Ea ratio may play a key role in the discrimination of several phenotypes in a multivariate model. As the medications and prognosis for HFpEF may be different from its phenotype,19, 20 it is urgent to elucidate the type of HFpEF or pre-HFpEF that should be medicated according to treatment type to reduce the incidence of admission for HF and mortality in the era of a super-ageing society. Among elderly clinic patients, we must detect symptomatic outpatients with possible HFpEF as well as asymptomatic ‘pre-HFpEF’ outpatients to reduce admission for HF in the near future and to conserve resources in the era of a super-ageing society. A vascular resistance-integrated LV diastolic index, (E/e')/(0.9 × systolic blood pressure), may play a role in revealing these patients in addition to possible comorbidities. None. No funding was received in relation to this article.

Heart failure with preserved ejection fraction (HFpEF) is a multifaceted syndrome, likely stemming from comorbidity-induced inflammation resulting in endothelial dysfunction. Endothelial glycocalyx degradation's role in the development and prognosis of HFpEF remains largely unexplored. Our study aimed at exploring the association between glycocalyx degradation and diastolic dysfunction and determining whether glycocalyx degradation can predict clinical outcomes in patients with HFpEF. Perlecan and thrombomodulin concentrations were assessed in individuals deemed healthy (STANISLAS [Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (Annual Noninvasive Temporary Monitoring of the Health of Insured Lorrainers)] cohort, n=1705) and patients with HFpEF (MEDIA-DHF [Metabolic Road to Diastolic Heart Failure], n=460 and BIOSTAT-CHF [Biology Study to Tailored Treatment in Chronic Heart Failure], n=556) to evaluate endothelial glycocalyx degradation. In patients with HFpEF, perlecan but not thrombomodulin was increased compared with controls (P<0.0001 versus P=0.73). In adjusted analysis, perlecan was associated with peak early mitral inflow velocity/peak early diastolic mitral annular velocity ratio and thrombomodulin with peak early diastolic mitral annular velocity in control individuals, whereas perlecan and thrombomodulin were associated with peak early mitral inflow velocity/peak early diastolic mitral annular velocity and left atrial volume index in patients with HFpEF (all P<0.03). Perlecan was significantly associated with cardiovascular hospitalization and death in the MEDIA-DHF (adjusted hazard ratio [HR] for highest tertile versus first tertile, 2.44 [95% CI, 1.11-5.34]; P=0.026) and BIOSTAT-CHF cohorts (adjusted HR, 2.12 [95% CI, 1.49-3.03]; P<0.0001). Thrombomodulin was associated with a worse outcome in BIOSTAT-CHF (P=0.004) but not in MEDIA-DHF. Higher circulating levels of the endothelial glycocalyx degradation biomarkers like perlecan and, to a lesser extent, thrombomodulin are associated with features of diastolic dysfunction in population and HFpEF settings and predict poor outcome in patients with HFpEF. These results suggest that glycocalyx degradation may be an early step in the pathological processes leading to HFpEF and gain further prognostic value in later stages (ie, overt HFpEF). URL: https://clinicaltrials.gov/; Unique identifiers: NCT01391442, https://clinicaltrials.gov/study/NCT01391442?cond=stanislas&rank=1; NCT02446327; URL: https://cordis.europa.eu; BIOSTAT-CHF ID: 242209.

Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality, and modern medicine offers less effective treatment for HFpEF. Much evidence shows that Chinese traditional patent medicines (CTPMs) have good efficacy for HFpEF, but the advantages and disadvantages of different CTPMs for HFpEF are still unclear. This study used network meta-analysis (NMA) to compare clinical efficacies of different CTPMs for HFpEF. Randomized controlled trials (RCTs) of CTPMs for treating HFpEF were searched in seven Chinese and English databases from inception to September 2023: China National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biology Medicine, PubMed, Cochrane Library, and Embase. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies. The GeMTC package in R (version 4.1.2) was used to perform Bayesian NMA. A total of 64 RCTs were included, involving six CTPMs and 6,238 patients. The six CTPMs were Qili Qiangxin capsule (QLQXC), Qishen Yiqi dropping pill (QSYQDP), Yixinshu capsule (YXSC), Yangxinshi tablet (YXST), Shexiang Baoxin Pill (SXBXP), and Tongxinluo capsule (TXLC). Conventional Western medicine (CWM) treatment was given to the control group, and CWM treatment combined with CTPM treatment was given to the experimental group. The results indicated that CPTMs + CWM were all superior to CWM alone; SXBXP + CWM had the best efficacies in improving the New York Heart Association cardiac functional classification efficiency; TXLC + CWM was best at improving the ratio of early diastolic mitral inflow velocity to late diastolic mitral inflow velocity (E/A); QSYQDP + CWM was best at reducing N-terminal pro-B type natriuretic peptide (NT-proBNP); and QSYQDP + CWM was best at improving the 6-min walking test. In terms of safety, there was no significant difference between CTPMs + CWM and CWM. Compared with CWM alone, CTPMs + CWM combinations have certain advantages and good safety in the treatment of HFpEF. QSYQDP + CWM and SXBXP + CWM may be the potential optimal integrative medicine-based treatments for HFpEF. Given the limitations of this study, further high-quality, multicenter, large sample, randomized, and double-blind studies are needed to confirm the current results. identifier, CRD42022303938.

The objective of this study was to determine the optimal assessment of arterial stiffness that relates to diastolic dysfunction. Forty-one patients had measurements of brachial-ankle pulse wave velocity (baPWV), carotid-femoral pulse wave velocity (cfPWV), ankle brachial index (ABI), pulse pressure (PP), and augmentation index (AIx). Diastolic dysfunction was evaluated by echocardiographic indices of the ratio of the peak early diastolic mitral valve velocity and the peak late diastolic velocity (E/A ratio), left atrial diameter, and left atrial volume indexes. There was a significant (P < 0.05) correlation between baPWV and E/A ratio with an inverse relationship indicating that higher arterial stiffness was associated with greater diastolic dysfunction. In contrast, there was no significant correlation between E/A ratio and cfPWV, PP, ABI, or AIx. After multivariate analysis, the relationship between baPWV and E/A ratio remained significant (P < 0.05), independent of age and systolic blood pressure (BP). There were no correlations between any index of vascular stiffness and left atrial dimension or volume. In summary, baPWV correlates with diastolic dysfunction, independent of a patient's age and BP and is a better indicator of diastolic dysfunction than other indicators of arterial stiffness. baPWV has the utility of infering the presence of left ventricular diastolic dysfunction.

To identify the relationship between serum fetuin-A levels and left ventricular diastolic dysfunction (LVDD) among maintenance haemodialysis patients. In a cross-sectional study, 75 dialysis patients with end-stage renal disease (ESRD) were recruited, and fetuin-A levels were detected using an enzyme-linked immunosorbent assay (ELISA). Echocardiography measurements were recorded according to the recommendations of the American Society of Echocardiography. The ratio of early diastolic transmitral inflow velocity (E) to early diastolic annular velocity (E') was measured using tissue Doppler imaging and E/E' > 15 was defined as diastolic dysfunction. The association of serum fetuin-A concentrations with echocardiographic parameters was analysed by calculating the bivariate linear correlation. A binary logistic regression analysis was conducted to determine the variables associated with LVDD. Compared to patients without diastolic dysfunction, patients with diastolic dysfunction were older, a higher percentage had a history of coronary artery disease, and presented with a high systolic pressure, high parathyroid hormone level, high N-terminal pro-brain natriuretic peptide (NT-proBNP) level, high LV mass index, high left atrium diameter, and low serum creatinine and fetuin-A levels. Serum fetuin-A levels showed a negative correlation with E/E' (r = -0.299, P = 0.009). Fetuin-A levels were considered an independent predictor of diastolic dysfunction. A decrease in the serum fetuin-A level is associated with an increased risk of LVDD in patients on haemodialysis.