Prevalence, clinical characteristics, quality of life, and prognosis of patients with congestive heart failure and isolated left ventricular diastolic dysfunction

https://doi.org/10.1016/j.echo.2003.11.002Get rights and content

Abstract

Prevalence of isolated left ventricular (LV) diastolic dysfunction has been reported to be as high as one-third of all heart failure (HF) cases, with an increasing prevalence in the elderly population. However, there is a paucity of prospective data about the prevalence and prognosis of isolated LV diastolic dysfunction in an unselected population of patients hospitalized with HF. Therefore, we prospectively evaluated 179 consecutive patients discharged from our hospital with HF to assess the prevalence of systolic versus diastolic LV dysfunction among patients hospitalized with HF and to compare their demographics, clinical features, self-perceived quality of life (QOL), and 6-month readmission rate and mortality. Among them, 133 (59% men, median age 74 years) showed in sinus rhythm and had no significant primary valvular disease. LV diastolic dysfunction was diagnosed on the basis of the European Study Group on Diastolic HF echocardiographic criteria. QOL was assessed at hospital discharge and 6-month follow-up visit using the Minnesota Living with HF questionnaire. Survival of patients with HF was compared with that of age- and sex-matched general population. In all, 29 patients (22%) had isolated LV diastolic dysfunction and 102 (78%) had prevalent LV systolic dysfunction (ie, LV ejection fraction ≤ 45%). There was no difference in age, sex, or New York Heart Association functional class between patients with LV diastolic or systolic dysfunction. QOL scores were similar between the 2 patient groups with HF both at discharge (39.4 and 34) and at 6-month visit (10.4 and 10.4). Both 6-month readmission rate (48% and 48%) and median inhospital length-of-stay during readmissions (10 days and 10 days) were similar between the 2 patient groups with HF. Finally, 6-month survival, adjusted for age and sex, was similar between patients with LV diastolic or systolic dysfunction (hazard ratio 0.68; 95% confidence interval 0.20-2.35). Using standardized echocardiographic criteria, isolated LV diastolic dysfunction among unselected patients hospitalized with HF was less than previously reported. Patients with HF and isolated diastolic dysfunction showed similar clinical symptoms, self-perceived QOL, readmission rate, and 6-month mortality to patients with prevalent LV systolic dysfunction.

Section snippets

Patients

The patient cohort included patients < 85 years of age and with adequate 2-dimensional echocardiographic study who were discharged with a primary diagnosis of HF from the 4 departments of internal medicine or from the department of cardiology of the S Maria della Misericordia, Udine, Italy, a 790-bed tertiary hospital that is part of an academic medical center, between April 1999 and January 2000. Demographic information about the catchment area of our hospital are available from published

Study population

A total of 145 patients (median age 75 years; 50% men) met the inclusion criteria. Among these, 12 patients were excluded because of inadequate Doppler echocardiographic studies in 9 (5%) and significant valvular heart disease other than mitral regurgitation as a result of mitral anulus dilation in 3 (2%). Finally, 2 patients did not show any evidence of systolic or diastolic LV dysfunction. Among the remaining 131 study patients, there were 29 patients (22%) with isolated LV diastolic

Discussion

This study was performed in a well-defined cohort of patients consecutively discharged from our hospital with a confirmed diagnosis of HF, and used standardized echocardiographic criteria for diagnosing isolated LV diastolic dysfunction. Our findings can be summarized as follows: (1) prevalence of isolated LV diastolic dysfunction in patients hospitalized with HF encompass 22% of patients in sinus rhythm and without significant valvulopathy; (2) patients given the diagnosis of isolated LV

Acknowledgements

We thank Pasquale Gianfagna, MD, and Rosanna Ciani, MD, for their help in performing a number of echocardiograms. We also thank the internists of our hospital who referred their patients to our echocardiographic laboratory. Finally, we are indebted to Dario Gregori, PhD, for his expert statistical analysis of data.

References (29)

  • M. Senni et al.

    Congestive heart failure in the communitya study of all incident cases in Olmsted county, Minnesota, in 1991

    Circulation

    (1998)
  • J.B. O'Connell et al.

    Economic impact of heart failure in the United Statestime for a different approach

    J Heart Lung Transplant

    (1994)
  • S.P. Friedrich et al.

    Intracardiac angiotensin converting enzyme inhibition improves diastolic function in patients with left ventricular hypertrophy due to aortic stenosis

    Circulation

    (1994)
  • W.J. Paulus et al.

    Acute effects of nitric oxide on left ventricular relaxation and diastolic distensibility in humans

    Circulation

    (1994)
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