Doppler-Derived Diastolic Flow Indices in African Americans
Doppler-Derived Diastolic Flow Indices in African Americans
Objectives: The objective of this study is to investigate the distribution and determinants of diastolic function in a middle-aged cohort of African Americans (AA).
Background: The distribution and determinants of left ventricular (LV) diastolic function in AA are not well-described despite high rates of AA with diastolic heart failure and a five-fold higher risk of death in those with diastolic dysfunction (DD) compared to normal diastolic function.
Methods: Four categories of diastolic function were defined in JHS participants undergoing echocardiograms at the first examination (2001-2004) using mitral and pulmonary vein velocities. Investigators used logistic regression to assess the independent relation of DD to traditional risk factors and LV systolic dysfunction.
Results: Of the 3,571 study participants (mean age, 56 ± 12 years; 63.9% female), 70.4% had normal diastolic function, and 18.0%, 10.6%, and 0.9% had mild, moderate, and severe DD, respectively. In the multivariable analysis, DD was significantly related to age (OR 1.2, 95% CI 1.1-1.4), male sex (OR 1.3 CI 1.0-1.5), LV systolic dysfunction (OR 1.5, CI 1.2-2.0), body mass index (OR 0.8, CI 0.8-0.9), and heart rate (OR 1.2; CI 1.1-1.2). The severity of DD was significantly related with age (OR 0.3; CI 0.3, 0.4), male sex (OR 1.6; CI 1.2-2.2), hypertension (OR 0.6, CI 0.4-0.8), and heart rate (OR 0.7; CI 0.6-0.8).
Conclusion: This is the largest community-based analysis of LV diastolic function in middle-aged AA. DD was present in 29.5% and independently related to several traditional risk factors and LV systolic dysfunction.
Doppler-based diastolic filling abnormalities of the left ventricle (LV) measured on echocardiogram is a predictor of adverse outcome in patients with heart disease. Even patients with mild forms of diastolic dysfunction (DD) and who are asymptomatic have a 5-fold greater risk of death compared to similar patients with normal LV diastolic function.
Several studies have shown that with careful methodical approach, Doppler flow patterns can document a progressive pattern of abnormality in many conditions affecting the myocardium. This reinforces the importance of studying diastolic ventricular function in individuals using Doppler echocardiographic assessment in mild cardiac conditions or hypertension so that the abnormalities can be identified at an early stage and possibly corrected. Though a number of population-based echocardiographic studies have been performed to study the prevalence of DD in non-African American (AA) populations, no study to date has evaluated the prevalence and severity of DD in a large middle-aged to elderly AA community using both mitral and pulmonary venous Doppler patterns on echocardiography.
Abstract and Introduction
Abstract
Objectives: The objective of this study is to investigate the distribution and determinants of diastolic function in a middle-aged cohort of African Americans (AA).
Background: The distribution and determinants of left ventricular (LV) diastolic function in AA are not well-described despite high rates of AA with diastolic heart failure and a five-fold higher risk of death in those with diastolic dysfunction (DD) compared to normal diastolic function.
Methods: Four categories of diastolic function were defined in JHS participants undergoing echocardiograms at the first examination (2001-2004) using mitral and pulmonary vein velocities. Investigators used logistic regression to assess the independent relation of DD to traditional risk factors and LV systolic dysfunction.
Results: Of the 3,571 study participants (mean age, 56 ± 12 years; 63.9% female), 70.4% had normal diastolic function, and 18.0%, 10.6%, and 0.9% had mild, moderate, and severe DD, respectively. In the multivariable analysis, DD was significantly related to age (OR 1.2, 95% CI 1.1-1.4), male sex (OR 1.3 CI 1.0-1.5), LV systolic dysfunction (OR 1.5, CI 1.2-2.0), body mass index (OR 0.8, CI 0.8-0.9), and heart rate (OR 1.2; CI 1.1-1.2). The severity of DD was significantly related with age (OR 0.3; CI 0.3, 0.4), male sex (OR 1.6; CI 1.2-2.2), hypertension (OR 0.6, CI 0.4-0.8), and heart rate (OR 0.7; CI 0.6-0.8).
Conclusion: This is the largest community-based analysis of LV diastolic function in middle-aged AA. DD was present in 29.5% and independently related to several traditional risk factors and LV systolic dysfunction.
Introduction
Doppler-based diastolic filling abnormalities of the left ventricle (LV) measured on echocardiogram is a predictor of adverse outcome in patients with heart disease. Even patients with mild forms of diastolic dysfunction (DD) and who are asymptomatic have a 5-fold greater risk of death compared to similar patients with normal LV diastolic function.
Several studies have shown that with careful methodical approach, Doppler flow patterns can document a progressive pattern of abnormality in many conditions affecting the myocardium. This reinforces the importance of studying diastolic ventricular function in individuals using Doppler echocardiographic assessment in mild cardiac conditions or hypertension so that the abnormalities can be identified at an early stage and possibly corrected. Though a number of population-based echocardiographic studies have been performed to study the prevalence of DD in non-African American (AA) populations, no study to date has evaluated the prevalence and severity of DD in a large middle-aged to elderly AA community using both mitral and pulmonary venous Doppler patterns on echocardiography.
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