Coronary artery disease
Prevalence and Prognosis of Asymptomatic Left Ventricular Diastolic Dysfunction in Ambulatory Patients With Coronary Heart Disease

https://doi.org/10.1016/j.amjcard.2007.01.041Get rights and content

The association of asymptomatic left ventricular (LV) diastolic dysfunction with cardiovascular outcomes in ambulatory patients with coronary heart disease (CHD) and no history of heart failure (HF) was examined. LV diastolic HF predicts adverse cardiovascular outcomes. However, the prevalence and prognosis of asymptomatic LV diastolic dysfunction in patients with established CHD in the absence of clinical HF is unknown. Six hundred ninety-three patients with stable CHD, normal systolic function (LV ejection fraction ≥50%), and no history of HF were evaluated. Echocardiography was used to classify LV diastolic function, and Cox proportional hazards models were used to evaluate the association of LV diastolic dysfunction with cardiovascular outcomes during 3 years of follow-up. Of 693 subjects with normal systolic function and no history of HF, 455 (66%) had normal LV diastolic function, 166 (24%) had mild LV diastolic dysfunction, and 72 (10%) had moderate to severe LV diastolic dysfunction. After multivariable adjustment, the presence of moderate to severe LV diastolic dysfunction was strongly predictive of incident hospitalization for HF (hazard ratio 6.3, 95% confidence interval 2.4 to 16.1, p = 0.0003) and death from heart disease (HR 3.9, 95% confidence interval 1.0 to 14.8, p = 0.05). In conclusion, moderate to severe LV diastolic dysfunction was present in 10% of patients with stable CHD with normal ejection fraction and no history of HF and predicts subsequent hospitalization for HF and death from heart disease. Patients with asymptomatic LV diastolic dysfunction may benefit from more aggressive therapy to prevent or delay the development of HF.

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Patients

Patients were enrolled in the Heart and Soul Study, a prospective cohort study investigating the influence of psychosocial factors on cardiovascular events. Methods were described previously.5 Administrative databases were used to identify outpatients with documented coronary artery disease at 2 Department of Veterans Affairs medical center databases (San Francisco and Palo Alto, California), 1 university-based medical center (University of California Medical Center–San Francisco), and 9 public

Results

Of 693 patients with LV ejection fraction ≥50% and no history of HF, 455 (66%) had normal LV diastolic function, 166 (24%) had impaired relaxation (mild LV diastolic dysfunction), and 72 (10%) had pseudonormal or restrictive filling (moderate to severe LV diastolic dysfunction). Compared with patients with normal LV diastolic function, those with LV diastolic dysfunction were older; more likely to have experienced a previous myocardial infarction, stroke, or revascularization; and less likely

Discussion

We found that moderate to severe LV diastolic dysfunction was present in 10% of outpatients with CHD who had no systolic dysfunction or history of HF. The presence of asymptomatic moderate to severe LV diastolic dysfunction predicted a more than sixfold increased risk of incident HF and an almost fourfold increased risk of death from heart disease. The increased risk of cardiovascular events associated with asymptomatic LV diastolic dysfunction was similar to that observed for patients with

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This work was supported by grants from the Department of Veterans Affairs, Washington, DC; Grant No. R01 HL079235 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the American Federation for Aging Research (Paul Beeson Scholars Program), New York, New York; the Robert Wood Johnson Foundation (Faculty Scholars Program), Princeton, New Jersey, the Ischemia Research and Education Foundation; and the Nancy Kirwan Heart Research Fund, San Francisco, California.

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