Abstract 1851: Diastolic Dysfunction: Prevalence in Referral Echo Laboratory
Background and Objective. The incidence of diastolic dysfunction (DD) with the community is approximately 10% in persons >45years (i.e., Olmsted County, MN) and ≈50% of heart failure patients have a normal EF. However, in a referral echo laboratory the incidence of DD appears to be even higher. We retrospectively reviewed the incidence and distribution of increased left atrial volume index (LAVI) and DD grade (DFG) within an outpatient referral cardiac ultrasound laboratory. LAVI is well documented, in older persons, to reflect chronic DD (i.e., elevated filling pressure).
Methods. Within a defined area of the Mayo CV Echo Laboratory, over a period of 1 month (approximately 20 exams/day), 399 consecutive patients underwent a complete transthoracic echo/Doppler examination (TTE). Left atrial volume index (LAVI) (biplane area-length method) was categorized as normal <28ml/m2 and increased ≥28ml/ m2; resting DFG; and indexed left ventricular end systolic volume (LVESVI) (biplane area-length method) measured. Spearman’s rank correlation (r) and the Kruskal-Wallis test were used to examine the chronic DD (LAVI) and resting DD (DFG, Valsalva maneuver, Tissue Doppler e’, E/e’ ratio). Linear regression on the natural logarithm of LAVI was used to create a multivariate model.
Results. Of the 399 patients 29 had no assessment of DD (transplantation, etc.). Of the remaining 370 patients [mean age 64 ± 15; male 196 (53%)], mean LAVI was 41.2 ± 18; (median 36.9), normal volume (<28ml/m2) in 83 (22%) and increased in 287 (78%). EF was ≥50% in 320 (87%); among those with EF ≥50%, 76% had increased LAVI and 88% among those with EF <50% (p<0.07). Median LAVI increased with increasing DFG (medians 30, 36, 41, 52 for grades 0 to 3 respectively, p<0.0001). Age, LVESVI and DFG were significantly associated (p<0.0001) with log LAVI in a multivariate model.
Conclusion. In a referral echo/Doppler laboratory (78%) of patients had an abnormal LAVI and features of any DD. Increased LAVI was present in 76% of those with normal EF. Within the “current epidemic of age-associated (mean 64 yr) cardiovascular disease” DD is very common. LAVI appears to be a robust quantifiable biomarker of the physiological burden irrespective of systolic function.