title: Impaired physical quality of life in patients with diastolic dysfunction associates more strongly with neurohumoral activation than with echocardiographic parameters: quality of life in diastolic dysfunction.
abstract: BACKGROUND
  Quality of life (QoL) is impaired in diastolic heart failure. Little is known about QoL in diastolic dysfunction (DD) without heart failure.
  
  
  METHODS
  In the DIAST-CHF observational study, outpatients with risk factors for or a history of heart failure were included. In a cross-sectional analysis, we classified patients with preserved systolic function as having normal diastolic function (N, n = 264) or DD without (DD-, n = 957) or with (DD+, n = 321) elevated filling pressures according to echocardiography. Quality of life was evaluated by the Short Form 36 (SF-36) questionnaire.
  
  
  RESULTS
  Short Form 36 physical function (SF-36-PF) was worse in DD+ (mean ± SD 67.2 ± 25.6) than in DD- (76.2 ± 22.7, P < .05) than in N (mean ± SD 81.1 ± 23.5, P < .01). Other physical dimensions and the physical component score were also lower in DD, whereas the mental component score did not differ. The SF-36-PF correlated weakly with echocardiographic indicators of diastolic function. In multivariate linear regression controlling for age, sex, body mass index, depressiveness as assessed by Patient Health Questionnaire 9, N-terminal probrain-type natriuretic peptide, and midregional proadrenomedullin (MR-proADM), individual echocardiographic parameters or grade of DD was not independently associated with SF-36-PF, whereas the presence of DD+ was. Both N-terminal probrain-type natriuretic peptide and MR-proADM were independently associated with SF-36-PF, with MR-proADM showing the stronger association.
  
  
  CONCLUSIONS
  Physical dimensions of QoL are reduced in DD. Impaired SF-36-PF is only weakly associated with DD per se but rather seems to be contingent on the presence of elevated filling pressures. Biomarkers are more strongly and independently associated with SF-36-PF and may be more adequate surrogate markers of QoL in DD than echocardiographic measurements.
authors.affiliation: Department of Cardiology and Pneumology, University of Göttingen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Edelmann
authors.forename: Raoul
authors.initials: R
authors.lastname: Stahrenberg
authors.forename: Friederike
authors.initials: F
authors.lastname: Polzin
authors.forename: Anke
authors.initials: A
authors.lastname: Kockskämper
authors.forename: Hans-Dirk
authors.initials: HD
authors.lastname: Düngen
authors.forename: André
authors.initials: A
authors.lastname: Duvinage
authors.forename: Lutz
authors.initials: L
authors.lastname: Binder
authors.forename: Jan
authors.initials: J
authors.lastname: Kunde
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuss
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.forename: Rolf
authors.initials: R
authors.lastname: Wachter
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
mesh_terms: D053607:Adrenomedullin / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D054144:Heart Failure, Diastolic / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011498:Protein Precursors / Q000097:blood; D011788:Quality of Life; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin