IMPACT OF DIFFERENT GRADING APPROACHES ON THE PREVALENCE AND PROGNOSTIC SIGNIFICANCE OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN THE GENERAL POPULATION

Abstract

Objective: Left ventricular (LV) diastolic function can be evaluated using a combination of echocardiographic indices. Grading of diastolic dysfunction (DD) is important for risk assessment in asymptomatic subjects especially in patients with hypertension or diabetes. Here, we compared the prevalence of LVDD and its prognostic significance in the general population using two grading approaches: the recent 2016 ASE/EACVI recommendations and population-derived, age-specific criteria (the FLEMENGHO study criteria). Design and method: In 792 randomly recruited participants (mean age, 50.8 years; 51.8% women; 41.2% hypertensive subjects and 56.7% with one or more cardiovascular risk factors) using conventional echocardiography and Doppler imaging, we measured left heart dimensions, tricuspid regurgitation, transmitral blood flow and mitral annular tissue velocities. Results: According to the 2016 recommendation, only 5 subjects (0.63%) were classified as having LVDD, whereas in 117 participants (14.8%) diastolic function was indeterminate. When applying the FLEMENGHO criteria, the prevalence of any grade of LVDD was 24.7% (n = 196). During the follow-up period (median 9 years), 105 and 78 participants experienced cardiovascular and cardiac endpoints, respectively. After full adjustment, we did not observe any significant differences in the risk of cardiovascular or cardiac events between subjects with LVDD or indeterminate diastolic function, and subjects with normal diastolic function when classified according to the 2016 recommendation (P = 0.44). In contrast, the risks of all cardiovascular (HR = 1.20; P = 0.037) and cardiac events (HR = 1.34; P = 0.0049) were significantly elevated in participants with advanced stages of LVDD (n = 118) as compared to subjects with normal LVDF when classified according to the FLEMENGHO study criteria. Conclusions: In the general population, the application of the 2016 recommendations led to a lower prevalence of subclinical LVDD and an underestimation of cardiovascular risk in asymptomatic subjects as compared to the population-based, age-specific grading approach.