Longitudinal Changes in Diastolic Dysfunction in Heart Failure with Reduced Ejection Fraction: Clinical and...

Diastolic dysfunction (DD) in heart failure with reduced ejection fraction (HFrEF) is relatively understudied, particularly regarding longitudinal changes in DD after HFrEF diagnosis and their clinical and echocardiographic associations.

This retrospective study included 360 patients with HFrEF who visited heart failure (HF) clinics in King Salman Heart Center, Riyadh, Saudi Arabia, between October 2019 and January 2020. Associations between DD grades and patients' clinical characteristics and echocardiographic parameters at diagnosis and during follow-up were evaluated.

At diagnosis, left ventricular ejection fraction (LVEF) was 26.7% ( ± 7.2%), and 43.1%, 29.4%, and 27.5% of patients had grade III, II, and I DD, respectively. After 3.4 years, 65% and 57.5% of patients with grades III and II DD, respectively, improved by at least one grade. Concordant improvements in almost all diastolic parameters were observed. DD grade improvement was predicted by increased LVEF (P < 0.001), nonischemic HF etiology, and absence of myocardial infarction (P < 0.001). No associations were found with HF medications or cardiovascular risk factors. DD improvement was independently associated with improved New York Heart Association class (P = 0.008), lower B-type natriuretic peptide level (P < 0.001), and higher systolic blood pressure (P < 0.001), regardless of LVEF, age, and time since diagnosis.

In HFrEF, DD improves with better LVEF and absence of ischemia or infarction. DD improvement is independently associated with improved New York Heart Association class, systolic blood pressure, and B-type natriuretic peptide level, suggesting that in HFrEF, diastolic HF coexists with and parallels systolic HF severity, and contributes independently to symptoms and hemodynamics.