title: Progression of left ventricular diastolic dysfunction and risk of heart failure.
abstract: BACKGROUND
  Heart failure incidence increases with advancing age, and approximately half of patients with heart failure have preserved left ventricular ejection fraction. Although diastolic dysfunction plays a role in heart failure with preserved ejection fraction, little is known about age-dependent longitudinal changes in diastolic function in community populations.
  
  
  OBJECTIVE
  To measure changes in diastolic function over time and to determine the relationship between diastolic dysfunction and the risk of subsequent heart failure.
  
  
  METHODS
  Population-based cohort of participants enrolled in the Olmsted County Heart Function Study. Randomly selected participants 45 years or older (N = 2042) underwent clinical evaluation, medical record abstraction, and echocardiography (examination 1 [1997-2000]). Diastolic left ventricular function was graded as normal, mild, moderate, or severe by validated Doppler techniques. After 4 years, participants were invited to return for examination 2 (2001-2004). The cohort of participants returning for examination 2 (n = 1402 of 1960 surviving [72%]) then underwent follow-up for ascertainment of new-onset heart failure (2004-2010).
  
  
  METHODS
  Change in diastolic function grade and incident heart failure.
  
  
  RESULTS
  During the 4 (SD, 0.3) years between examinations 1 and 2, diastolic dysfunction prevalence increased from 23.8% (95% confidence interval [CI], 21.2%-26.4%) to 39.2% (95% CI, 36.3%-42.2%) (P < .001). Diastolic function grade worsened in 23.4% (95% CI, 20.9%-26.0%) of participants, was unchanged in 67.8% (95% CI, 64.8%-70.6%), and improved in 8.8% (95% CI, 7.1%-10.5%). Worsened diastolic dysfunction was associated with age 65 years or older (odds ratio, 2.85 [95% CI, 1.77-4.72]). During 6.3 (SD, 2.3) years of additional follow-up, heart failure occurred in 2.6% (95% CI, 1.4%-3.8%), 7.8% (95% CI, 5.8%-13.0%), and 12.2% (95% CI, 8.5%-18.4%) of persons whose diastolic function normalized or remained normal, remained or progressed to mild dysfunction, or remained or progressed to moderate or severe dysfunction, respectively (P < .001). Diastolic dysfunction was associated with incident heart failure after adjustment for age, hypertension, diabetes, and coronary artery disease (hazard ratio, 1.81 [95% CI, 1.01-3.48]).
  
  
  CONCLUSIONS
  In a population-based cohort undergoing 4 years of follow-up, prevalence of diastolic dysfunction increased. Diastolic dysfunction was associated with development of heart failure during 6 years of subsequent follow-up.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Garvan C
authors.initials: GC
authors.lastname: Kane
authors.forename: Barry L
authors.initials: BL
authors.lastname: Karon
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Mahoney
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.forename: Veronique L
authors.initials: VL
authors.lastname: Roger
authors.forename: John C
authors.initials: JC
authors.lastname: Burnett
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rodeheffer
mesh_terms: D000368:Aged; D000375:Aging; D003971:Diastole; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012306:Risk; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000150:complications*