Clinical InvestigationDiastolic dysfunction revisited: A new, feasible, and unambiguous echocardiographic classification predicts major cardiovascular events
Section snippets
Study population
This study was performed as a substudy of the 4th Copenhagen City Heart Study,4., 27. a longitudinal cohort study of cardiovascular disease and risk factors. This study includes 2221 randomly selected men and women (age 20-93 years) who underwent echocardiographic examination including both conventional echocardiography and color TDI with measurement of septal and lateral peak early diastolic mitral annular velocities (e′). Whether a participant underwent echocardiography was completely
Population characteristics
The study population (n = 1851) was divided into groups with normal or impaired relaxation according to average septal and lateral e′ (Table I). Since myocardial relaxation is known to be impaired with increasing age, our finding of the group of persons with impaired relaxation being older than the group with normal relaxation was expected. The group of persons with impaired relaxation was also more likely to be diagnosed with hypertension, diabetes, and ischemic heart disease and had higher
Discussion
In this large community study, we found that impaired myocardial relaxation according to e′ was associated with a higher incidence of cardiovascular risk factors, cardiac dysfunction by echocardiography, and increased risk of cardiovascular events independently of age. In the subgroup of persons with impaired relaxation, several conventional echocardiographic measures of DDF were predictors of MACE, however, only LAVi ≥ 34 mL/m2, E/A > 2, and elevated filling pressures according to E/e′ remained
Conclusions
In the general population, we found that impaired myocardial relaxation according to e′ was associated with cardiovascular risk factors and increased risk of MACE. Furthermore, by contrast to persons with normal relaxation, the combination of impaired relaxation and echocardiographic markers of elevated filling pressures increased the risk of MACE significantly. Based on these findings, we present a new classification of DDF capable of accurately identifying persons at risk of MACE in the
Role of the funder/sponsor
The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript.
Author contributions
Dr Dyrby Johansen and Dr Mogelvang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Dyrby Johansen, Skov Jensen, Mogelvang.
Acquisition of data: Biering-Sorensen, Mogelvang.
Analysis and interpretation of data: Dyrby Johansen, Mogelvang.
Drafting of the manuscript: Dyrby Johansen, Mogelvang.
Critical revision of the manuscript for important intellectual content: Dyrby Johansen,
Conflicts of interest
None declared.
Acknowledgements and funding
This work was supported by grants from the Lundbeck Foundation, the Novo Nordisk Foundation, and the Danish Heart Foundation (07-10-R60-A1698-B132-22413).
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