Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults: The Atherosclerosis Risk in Communities Study
Background—While age-associated changes in LV diastolic function are well-recognized, limited data exist characterizing measures of diastolic function in older adults, including both reference ranges reflecting the older adult population and prognostically relevant values for incident HF, as well as their associations with circulating biomarkers of heart failure (HF) risk.
Methods—Among 5,801 elderly participants in the Atherosclerosis Risk in Communities (ARIC) study (age range 67-90, mean age 76 ± 5, 42% male, 21% black), we determined the continuous association of diastolic measures (TDI e', E/e', and left atrial size) with concomitant NT-proBNP and subsequent HF hospitalization or death. We also determined sex-specific 10th and 90th percentile limits for these measures using quantile regression in 401 participants free of prevalent cardiovascular disease and risk factors.
Results—Each measure of diastolic function was robustly associated with NT-proBNP and incident HF or death. ARIC-based reference limits for TDI e' (4.6 and 5.2 cm/sec for septal and lateral TDI e', respectively) were substantially lower than guideline cutpoints (7 and 10 cm/sec, respectively), while E/e' and LA size demonstrated good agreement with guideline cutpoints. TDI e' was non-linearly associated with incident HF or death, with inflection points for risk supportive of ARIC-based limits. ARIC-based limits for diastolic function improved risk discrimination over guideline-based cutpoints based on the IDI (p<0.001) and continuous NRI (p<0.001), reclassifying 42% of the study population as having normal diastolic function. We replicate these findings in the Copenhagen City Heart Study. Using these limits, 46% had normal diastolic function and were at low risk of HF hospitalization or death (1%/year over a mean 1.7 year follow-up), 49% had 1 or 2 abnormal measures and were at intermediate risk (2.4%/year), and all 3 diastolic measures were abnormal in 5% who were at high risk (7.5%/year).
Conclusions—Our findings suggest that LV longitudinal relaxation velocity declines as a part of healthy aging and is largely prognostically benign. The use of age-based normative values when considering an elderly population improves the risk discrimination of diastolic measures for incident HF or death.
- Received August 3, 2016.
- Revision received November 8, 2016.
- Accepted November 29, 2016.