Abstract 12731: Severity of LV Diastolic Stiffness as Assessed by the Diastolic Wall Strain Index is Associated With Worse Outcomes in Heart Failure With Preserved Ejection Fraction
Background: Increased LV diastolic stiffness is thought to contribute to the pathophysiology of heart failure with preserved EF (HFpEF). Currently, diastolic stiffness is inferred from Doppler indices which reflect filling pressures and myocardial relaxation. Diastolic wall strain (DWS), an index based on the linear elastic theory and calculated as: (LV end-systolic wall thickness — LV end-diastolic wall thickness) / LV wall end-systolic thickness, correlates inversely with the diastolic stiffness constant in animal models. The Objectives of this study were to verify that DWS reflects advanced diastolic dysfunction and that increased diastolic stiffness (as reflected by lower DWS) is predictive of outcome in HFpEF.
Methods: Prospective population-based HF surveillance study of consecutive HFpEF patients (n=244, EF≥50%; Framingham HF criteria) and 46 randomly sampled subjects without cardiovascular disease with a similar age distribution to the cases (Control) underwent echo and follow up for death or HF hospitalization (event free survival).
Results: DWS was measurable in 203 HFpEF pts and was lower in HFpEF (0.33 ± 0.08) than Control (0.40 ± 0.06, p<0.001). HFpEF patients with DWS < median (0.33) had worse diastolic indices (Table) and lower event free survival than those with DWS ≥ median (p=0.005, Figure) even after adjustment for age, E/E' and BNP (p<0.02).
Conclusions: These data suggest that DWS reflects LV diastolic stiffness and that increased diastolic stiffness contributes to the progression of HFpEF.
- © 2010 by American Heart Association, Inc.