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Interactive role of diastolic dysfunction and ventricular remodeling in asymptomatic subjects at increased risk of heart failure

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Abstract

Diastolic dysfunction (DD) and left ventricular remodeling (LVR) characterize patients at risk for heart failure (HF). To assess the prognostic impact of different diastolic function algorithms and a complex LVR classification (CRC) in asymptomatic subjects with preserved ejection fraction (EF) at risk for HF. We analyzed 1923 asymptomatic patients (male 43%; age 57, 33–76 years) with at least one cardiovascular risk factor and preserved (> 50%) EF. We used three algorithms for LV diastolic function assessment (Paulus et al. in Eur Heart J 28(20):2539–2550, 2007; Nagueh et al. in J Am Soc Echocardiogr 22(2):107–133, 2009, Eur Heart J Cardiovasc Imaging 17(12):1321–1360, 2016), and two algorithms for LVR (classic and CRC). We considered a composite end-point: cardiac death and hospitalization for HF. The highest presence of DD was diagnosed by Nagueh 2009 (211, 11%), while the prevalence according to Nagueh 2016 (63 patients, 3.2%) turned out to be the lowest (p < 0.001 vs the other algorithms). According to CRC, 780 (48.6%) patients had normal or physiologic hypertrophy, 298 (15.5%) concentric remodeling, 85 (4.4%) eccentric remodeling, 294 (15.3%) concentric hypertrophy, 39 (2%) mixed hypertrophy, 80 (4.1%) dilated hypertrophy, 73 (3.7%) eccentric hypertrophy and 294 (15.3%) were unclassifiable. After 39-month follow-up (261 events, 13.6%), Cox-regression (adjusted for age, gender, history of stable ischemic heart disease, classic remodeling classification) identified CRC (p = 0.01) and Nagueh 2016 (p < 0.001) as independent predictors of end-point. The coexistence of an adverse LVR by CRC and DD by Nagueh 2016 was associated with the worst prognosis. A concurrent structural (CRC) and functional (Nagueh Op. Cit) analysis improves prognostic stratification in asymptomatic subjects at risk for HF with preserved EF.

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Abbreviations

A-dur:

A-wave duration

A-wave velocity:

Pulsed wave trans-mitral flow end-diastolic wave velocity

CAD:

Coronary artery disease

CRC:

Complex remodeling classification

DD:

Diastolic dysfunction

DT:

E-wave deceleration time

E/A ratio:

Ratio of proto to tele-diastolic trans-mitral flow velocities

E/e’ ratio:

Ratio of proto-diastolic trans-mitral flow velocity to TDI average septal and lateral velocities

e’ wave velocity:

TDI mitral annular proto-diastolic wave velocity

EDD:

End-diastolic diameter

EDV:

Left ventricular end-diastolic volume

EF:

Ejection fraction

ESV:

Left ventricular end-systolic volume

E-wave velocity:

PW transmitral proto-diastolic wave velocity

HF:

Heart failure

LAVi:

Indexed left atrial volume

LV-EDVi:

Indexed left ventricular end-diastolic volume

LVH:

Left ventricular hypertrophy

LVMi:

Indexed left ventricular mass

LVR:

Left ventricular remodeling

PWT:

Posterior wall thickness

RWT:

Relative wall thickness

SIHD:

Stable ischemic heart disease

TR:

Tricuspid regurgitation

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Author notes

  1. Iacopo Fabiani and Nicola Riccardo Pugliese have contributed equally to this work and are joint first authors.

  2. Deceased: Vitantonio Di Bello.

Authors and Affiliations

  1. Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell’Area Critica, Università di Pisa, Via Paradisa, 2 - Ospedale Cisanello, Pisa, 56100, Italy

    Iacopo Fabiani, Nicola Riccardo Pugliese, Lorenzo Conte, Frank Lloyd Dini & Vitantonio Di Bello

  2. Ospedale Villa Sofia, Palermo, Italy

    Salvatore La Carrubba

  3. Azienda Ospedaliero Universitaria Policlinico - Bari U.O.C. Cardiologia Ospedaliera, Bari, Italy

    Paolo Colonna

  4. Azienda Ospedaliera Monaldi - Napoli, Napoli, Italy

    Pio Caso

  5. UOC Cardiologia Clinica e Riabilitativa Azienda Ospedaliera “Bianchi-Melacrino-Morelli” Reggio Calabria, Reggio Calabria, Italy

    Frank Benedetto

  6. Ospedale di Pordenone S. Maria degli Angeli-SSD Patologia Cardiovascolare ed Aterosclerosi, Pordenone, Italy

    Francesco Antonini-Canterin

  7. AOU “San Giovanni di Dio e Ruggiero d’Aragona” – Salerno, Salerno, Italy

    Rodolfo Citro

  8. Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Messina, Italy

    Scipione Carerj

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  1. Iacopo Fabiani
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  2. Nicola Riccardo Pugliese
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  8. Francesco Antonini-Canterin
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  10. Frank Lloyd Dini
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  12. Vitantonio Di Bello
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Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)

Corresponding author

Correspondence to Nicola Riccardo Pugliese.

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Fabiani, I., Pugliese, N.R., La Carrubba, S. et al. Interactive role of diastolic dysfunction and ventricular remodeling in asymptomatic subjects at increased risk of heart failure. Int J Cardiovasc Imaging 35, 1231–1240 (2019). https://doi.org/10.1007/s10554-019-01560-6

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  • DOI: https://doi.org/10.1007/s10554-019-01560-6

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