Diastolic Dysfunction in Heart Failure With Preserved Systolic Function: Need for Objective Evidence
Results From the CHARM Echocardiographic Substudy–CHARMES
Hans Persson, MD, PhD*,*,
Eva Lonn, MD, MSc ,
Magnus Edner, MD, PhD*,
Lawrence Baruch, MD ,
Chim C. Lang, MD ,
John J. Morton, PhD||,
Jan Östergren, MD, PhD¶,
Robert S. McKelvie, MD, PhD for the Investigators of the CHARM Echocardiographic Substudy–CHARMES
* Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital Department of Cardiology, Stockholm, Sweden
Population Health Research Institute and McMaster University, Hamilton, Canada
Bronx Veterans Affairs Medical Center, Mt. Sinai School of Medicine, Bronx, New York
Ninewells Hospital and Medical School, Dundee, United Kingdom
|| Western Infirmary, University of Glasgow, Glasgow, United Kingdom
¶ Department of Medicine, Karolinska University Hospital, Solna, Stockholm, Sweden.
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Figure 1 Classification of LV Diastolic Function
Left ventricular (LV) diastolic function categorized into 4 groups. 1) Normal: mitral inflow parameters within normal range and normal pulmonary vein flow or normal N-terminal pro-brain natriuretic peptide (NT-proBNP). 2) Abnormal relaxation: a) early filling peak velocity/atrial filling peak velocity (E/A) ratio lower than age-related value and/or b) isovolumic relaxation time/deceleration time (IVRT/DT) longer than age-related value. 3) Pseudonormal: normal mitral inflow parameters and a) elevated NT-proBNP, b) abnormal pulmonary venous flow, or c) abnormal E/A–E/A during Valsalva. 4) Restrictive: a) E/A ratio higher than age-related value and/or b) IVRT/DT shorter than age-related value. Pulmonary venous flow was considered abnormal if any one of the following criteria were present: 1) pulmonary vein systolic/diastolic velocity less than age-related value, 2) pulmonary vein a-duration longer than mitral a-duration, or 3) pulmonary vein peak a-velocity greater than age-related value. Normal values are in Table 1.
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Figure 2 CV Death or HF Hospitalization According to Diastolic Function Class
Univariate hazard ratios (95% confidence intervals) for relaxation abnormality versus normal = 1.4 (0.4 to 5.7); pseudonormal versus normal = 4.5 (1.5 to 13.2); and restrictive versus normal = 7.2 (1.8 to 29.0). CV = cardiovascular; HF = heart failure.
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Figure 3 CV Death or HF Hospitalization in Group With Pseudonormal Diastolic Function
Univariate hazard ratio (95% confidence intervals) for outcome in patients with pseudonormal diastolic dysfunction characterized by N-terminal pro-brain natriuretic peptide (NT-proBNP) versus Doppler = 0.8 (0.2 to 2.7). Abbreviations as in Figure 2.
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