title: Comparison of echocardiographic parameters between pre-clinical and clinical advanced diastolic dysfunction patients.
abstract: BACKGROUND
  The diagnosis of heart failure (HF) with preserved ejection fraction requires evidence of grade 2 or 3 (advanced) diastolic dysfunction (ADD), but many patients with ADD do not have clinical HF manifestations, hence termed pre-clinical diastolic dysfunction (PDD). The prevalence and characteristics of PDD in comparison to overt HF disease (clinical-ADD) are still debated.
  
  
  METHODS
  We retrospectively analyzed 373 patients with LVEF≥45% and ADD in our echo-lab database. Exclusion criteria were acute coronary syndromes, ≥moderate valvular disease, cardiomyopathies or pericardial disease. Patients were divided into 2 groups according to the presence/absence of HF symptoms, namely PDD (n=249) and clinical-ADD (n=124). Demographic, clinical and echocardiographic parameters were compared between the groups.
  
  
  RESULTS
  Age, gender and comorbidities were similar between groups, with only a higher body mass index and renal failure significantly more prevalent in the clinical-ADD patients. Neither LV mass nor the ADD severity was related to the presence of symptoms; lateral mitral E/E' and pulmonary artery systolic pressure were significantly higher in clinical-ADD patients (14±5 vs. 12±4, p<0.05 and 40±13 vs. 36±11mmHg, p<0.05, respectively) and were the only parameters to correlate with the presence of symptoms of clinical-ADD in multivariable logistic regression (odds ratio=1.07 (CI 1.02-1.1, p=0.008) and 1.03 (CI 1.01-1.05, p=0.01), respectively).
  
  
  CONCLUSIONS
  In patients referred for an echocardiogram at a community cardiology center, PDD was twice as common as clinical-ADD. Hemodynamic parameters reflecting elevated filling and pulmonary pressures, rather than traditional comorbidities and/or classical structural abnormalities, were the only parameters related to the presence of HF symptoms.
authors.affiliation: Department of Cardiology, B Padeh Medical Center, Poriya, Lower Galilee, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel. Electronic address: scarasso@poria.health.gov.il.
authors.forename: Shemy
authors.initials: S
authors.lastname: Carasso
authors.affiliation: Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Lynne K
authors.initials: LK
authors.lastname: Williams
authors.affiliation: Department of Cardiology, B Padeh Medical Center, Poriya, Lower Galilee, Israel.
authors.forename: Yevgeni
authors.initials: Y
authors.lastname: Hazanov
authors.affiliation: Department of Cardiology, B Padeh Medical Center, Poriya, Lower Galilee, Israel.
authors.forename: Yussra
authors.initials: Y
authors.lastname: Halhla
authors.affiliation: Department of Cardiology, B Padeh Medical Center, Poriya, Lower Galilee, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.
authors.forename: Diab
authors.initials: D
authors.lastname: Ghanim
authors.affiliation: Department of Cardiology, B Padeh Medical Center, Poriya, Lower Galilee, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.
authors.forename: Offer
authors.initials: O
authors.lastname: Amir
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006439:Hemodynamics; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology