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Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey
  1. W P Abhayaratna1,
  2. T H Marwick2,
  3. W T Smith3,
  4. N G Becker4
  1. 1National Centre for Epidemiology and Population Health, Australian National University and Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia
  2. 2Department of Medicine, University of Queensland, Brisbane, Queensland, Australia
  3. 3Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
  4. 4National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
  1. Correspondence to:
    Dr Walter P Abhayaratna
    National Centre for Epidemiology and Population Health, Australian National University and Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia; abhayaratna.walter{at}mayo.edu

Abstract

Objective: To determine the prevalence and predictors of left ventricular (LV) diastolic dysfunction in older adults.

Design, setting and participants: A cross-sectional survey of 1275 randomly selected residents of Canberra, aged 60 to 86 years (mean age 69.4; 50% men), conducted between February 2002 and June 2003.

Main outcome measures: Prevalence of LV diastolic dysfunction as characterised by comprehensive Doppler echocardiography.

Results: The prevalence of any diastolic dysfunction was 34.7% (95% CI 32.1% to 37.4%) and that of moderate to severe diastolic dysfunction was 7.3% (95% CI 5.9% to 8.9%). Of subjects with moderate to severe diastolic dysfunction, 77.4% had an LV ejection fraction (EF) > 50% and 76.3% were in a preclinical stage of disease. Predictors of diastolic dysfunction were higher age (p < 0.0001), reduced EF (p < 0.0001), obesity (p < 0.0001) and a history of hypertension (p < 0.0001), diabetes (p  =  0.02) and myocardial infarction (p  =  0.003). Moderate to severe diastolic dysfunction with normal EF, although predominantly preclinical, was independently associated with increased LV mass (p < 0.0001), left atrial volume (p < 0.0001), and circulating amino-terminal pro-B-type natriuretic peptide concentrations (p < 0.0001), and with decreased quality of life (p < 0.005).

Conclusion: Diastolic dysfunction is common in the community and often unaccompanied by overt congestive heart failure. Despite the lack of symptoms, advanced diastolic dysfunction with normal EF is associated with reduced quality of life and structural abnormalities that reflect increased cardiovascular risk.

  • CHF, congestive heart failure
  • DD-NEF, diastolic dysfunction and normal ejection fraction
  • EF, ejection fraction
  • LV, left ventricular, N-BNP, amino-terminal B-type natriuretic peptide

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Footnotes

  • Published Online First 17 February 2006

  • Competing interests: None declared.

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