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Comparison of echocardiographic parameters between pre-clinical and clinical advanced diastolic dysfunction patients
Shemy Carasso1, Lynne K Williams2, Yevgeni Hazanov3
1Department of Cardiology, B Padeh Medical Center, Poriya, Lower Galilee, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.
Insights
Pre-clinical diastolic dysfunction (PDD) is twice as common as symptomatic heart failure with preserved ejection fraction (HFpEF). Elevated filling and pulmonary pressures, not comorbidities, indicate HF symptoms in patients with advanced diastolic dysfunction.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF) requires advanced diastolic dysfunction (ADD).
- Many patients with ADD lack HF symptoms, termed pre-clinical diastolic dysfunction (PDD).
- Prevalence and characteristics of PDD versus clinical-ADD are debated.
Purpose of the Study:
- Compare demographic, clinical, and echocardiographic parameters between PDD and clinical-ADD patients.
- Identify factors associated with HF symptoms in patients with ADD.
Main Methods:
- Retrospective analysis of 373 patients with LVEF≥45% and ADD.
- Exclusion of patients with acute coronary syndromes, significant valvular disease, cardiomyopathies, or pericardial disease.
- Division into PDD (n=249) and clinical-ADD (n=124) groups based on HF symptoms.
Main Results:
- Higher body mass index and renal failure in clinical-ADD patients.
- LV mass and ADD severity did not correlate with symptoms.
- Lateral mitral E/E' and pulmonary artery systolic pressure were higher in clinical-ADD and correlated with symptoms.
Conclusions:
- PDD is twice as common as clinical-ADD in community cardiology settings.
- Elevated filling and pulmonary pressures are key indicators of HF symptoms in ADD.
- Hemodynamic parameters are more critical than comorbidities or structural abnormalities for symptom presence.
Background:
The diagnosis of heart failure (HF) with preserved ejection fraction requires evidence of grade 2 or 3 (advanced) diastolic dysfunction (ADD), but many patients with ADD do not have clinical HF manifestations, hence termed pre-clinical diastolic dysfunction (PDD). The prevalence and characteristics of PDD in comparison to overt HF disease (clinical-ADD) are still debated.
Methods:
We retrospectively analyzed 373 patients with LVEF≥45% and ADD in our echo-lab database. Exclusion criteria were acute coronary syndromes, ≥moderate valvular disease, cardiomyopathies or pericardial disease. Patients were divided into 2 groups according to the presence/absence of HF symptoms, namely PDD (n=249) and clinical-ADD (n=124). Demographic, clinical and echocardiographic parameters were compared between the groups.
Results:
Age, gender and comorbidities were similar between groups, with only a higher body mass index and renal failure significantly more prevalent in the clinical-ADD patients. Neither LV mass nor the ADD severity was related to the presence of symptoms; lateral mitral E/E' and pulmonary artery systolic pressure were significantly higher in clinical-ADD patients (14±5 vs. 12±4, p<0.05 and 40±13 vs. 36±11mmHg, p<0.05, respectively) and were the only parameters to correlate with the presence of symptoms of clinical-ADD in multivariable logistic regression (odds ratio=1.07 (CI 1.02-1.1, p=0.008) and 1.03 (CI 1.01-1.05, p=0.01), respectively).
Conclusions:
In patients referred for an echocardiogram at a community cardiology center, PDD was twice as common as clinical-ADD. Hemodynamic parameters reflecting elevated filling and pulmonary pressures, rather than traditional comorbidities and/or classical structural abnormalities, were the only parameters related to the presence of HF symptoms.
