title: Does left ventricular diastolic dysfunction progress through stages? Insights from a community heart failure study.
abstract: We performed a retrospective pilot study on a group of symptomatic patients attending our community heart failure clinic with left ventricular diastolic dysfunction (LVDD), rising or elevated LV end diastolic pressure, elevated brain natriuretic peptide (BNP), but with no clinical or radiographic evidence of heart failure; a group we hypothesised may be in the pre-HFPEF stage.
  
  
  METHODS
  Those with LVEF >45% and LV diastolic dysfunction were included and divided into two groups: E/e' <15 and E/e' ≥15 corresponding with rising and raised LVEDP, respectively. Clinical events (deaths and hospital admissions) were compared at 1year and were grouped into all-cause events or cardiovascular events. The total numbers of all-cause and cardiovascular events of the individual groups and the entire cohort were assessed at 1year.
  
  
  RESULTS
  Out of 584 screened, 80 patients were included. Thirty five patients had E/e' <15 and 45 had E/e' ≥15. At 1year follow-up the 1year all-cause events in the E/e' ≥15 group was higher compared to the E/e' <15 group (p=0.03). At 12months, in the entire cohort there were a total of 45 clinical events (39 hospital admissions and 6 deaths) out of which 20 events were cardiovascular.
  
  
  CONCLUSIONS
  Patients in the pre-HFPEF stage had many events and those with elevated E/e' ≥15 had a poor 1year outcome. As this was strongly influenced by comorbidities we suggest close monitoring of these patients in dedicated HFPEF clinics along with vigorous management of comorbidities.
authors.affiliation: Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom; Department of Cardiology, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, United Kingdom. Electronic address: prithwish.banerjee@uhcw.nhs.uk.
authors.forename: Prithwish
authors.initials: P
authors.lastname: Banerjee
authors.affiliation: Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
authors.forename: Aamir
authors.initials: A
authors.lastname: Motiwala
authors.affiliation: Department of Cardiology, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, United Kingdom.
authors.forename: Hanif Muhammad
authors.initials: HM
authors.lastname: Mustafa
authors.affiliation: Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
authors.forename: Mohammed Akil
authors.initials: MA
authors.lastname: Gani
authors.affiliation: Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
authors.forename: Samih
authors.initials: S
authors.lastname: Fourali
authors.affiliation: Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom; Department of Cardiology, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, United Kingdom.
authors.forename: Danish
authors.initials: D
authors.lastname: Ali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006760:Hospitalization / Q000639:trends; D006801:Humans; D057187:Independent Living / Q000639:trends; D008297:Male; D010865:Pilot Projects; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy
keywords: Community heart failure clinic; Comorbidities; HFPEF; Hospital admissions; Mortality