Heart failure risk rises in people with diastolic dysfunction: Study

By Dr. Ananya Mandal, MDAug 24 2011

New research suggests that a common form of heart trouble called diastolic dysfunction appears to worsen over time and may lead to an increased risk of heart failure. In people with diastolic dysfunction, which often comes with advancing age, the heart's left ventricle fills with blood in an abnormal way and is accompanied by elevated filling pressures.

This new research included more than 2,000 people aged 45 and older who participated in Minnesota's Olmsted County Heart Function Study. They were assessed from 1997 to 2000, and their diastolic left ventricular function was graded as being normal or having mild, moderate or severe dysfunction.

All the participants were examined again between 2001 and 2004, and more than 1,400 of them underwent follow-up testing for new-onset heart failure between 2004 and 2010.

Between the first and second examination, the prevalence of diastolic dysfunction of any degree increased from about 24 percent to more than 39 percent. Moderate or severe diastolic dysfunction rose from 6.4 percent to 16 percent. During the four years between examinations, diastolic function worsened in just over 23 percent of participants, remained unchanged in about 68 percent and improved in around 9 percent. Older people, especially those over 65, were more likely to develop diastolic dysfunction.

During the more than six years of follow-up after the second examination, 81 people developed heart failure. Those aged 65 and older were most likely to develop heart failure. Persistent or worsening diastolic dysfunction was associated with heart failure, the researchers said.

The study is published Aug. 24 in the Journal of the American Medical Association.

“Cumulative heart failure incidence was 2.6 percent in participants whose diastolic function remained normal or normalized between examinations; 7.8 percent in those with persistent, or progression to mild diastolic dysfunction; and 12.2 percent in those with persistent, or progression to moderate or severe diastolic dysfunction,” wrote Dr. Garvan C. Kane, of the Mayo Clinic and Medical School in Rochester, Minn., and colleagues in a journal news release

“That diastolic dysfunction worsened even in healthy persons supports the concept that aging may be accompanied by progressive deterioration in diastolic function. This age-related progression of diastolic dysfunction in the population contributes to the pathophysiologic substrate from which overt heart failure emerges,” said Dr. Kane.

“Specifically, our findings are consistent with the hypothesis that a combination of cardiovascular aging and superimposed cardiovascular disease accelerates the deterioration in diastolic function, setting the stage for symptomatic heart failure with preserved LVEF in elderly persons,” researchers noted. It follows that preventing such superimposed events by addressing risk factors, particularly hypertension, “might be fundamental to reducing heart failure with preserved LVEF,” they added. The study findings may not be generalizable to nonwhite racial or ethnic populations, since the cohort was predominantly white.

This study was supported by the National Heart, Lung, and Blood Institute, the National Center for Research Resources, the Mayo Foundation, the National Institutes of Health, the Rochester Epidemiology Project, and the National Institute on Aging. No financial conflicts of interest were reported.