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Table 2 Studies investigating the progression from LVDD towards overt heart failure

From: Diastolic dysfunction and sex-specific progression to HFpEF: current gaps in knowledge and future directions

First author, year, cohort name (reference number)

Population under investigation

Number of individuals (% women)

Mean age in years

Follow-up in years

Percentage of individuals that developed heart failure (stage C/D)

Determinants of progression towards heart failure

Distinction between HFpEF and HFrEF

Sex-stratified analyses

Sex included in multivariable model. If included: independent predictor?

Ren, 2007, Heart and Soul study [85]

Stable CAD

639 (19%)

67

3

7% in those with mild diastolic dysfunction

11% in those with moderate-severe LVDD

Not investigated

No

Not performed

Yes, independence not reported

From, 2010, Olmsted County [82]

Diabetes mellitus

1760 (51%)

60

5

17% in those with diabetes

37% in those with diastolic dysfunction and diabetes

Not investigated

No

Not performed

Yes, not independent

Correa de Sa, 2010 [81]

Moderate or severe LVDD

82 (55%)

69

2

In those with moderate or severe LVDD 1.9% developed HF according to Framingham criteria and 31% developed signs or symptoms suggestive of HF (not explained by other conditions)

Peripheral vascular disease, hypertension

No

Not performed

No

Kane, 2011, Olmsted County [78]

General

1402 (51%)

61

6.3

7.8% in those mild diastolic dysfunction

12.2% in those with moderate-severe LVDD

Age, hypertension, diabetes, CAD, E/e′ ratio and LAVI

No

Not performed

No

Lam 2011, Framingham Heart Study [8]

General

1038 (61%)

76

11

23.8% of the population developed HF (~ 40% = HFpEF)

Renal impairment, airflow limitation and anemia

Yes

Not performed

Yes, independence not reported

Vogel, 2012, Olmsted County [79]

General

388 (57%)

67

3

11.6% in those with grade II to IV LVDD

Age, right ventricular systolic pressure, GFR < 60 mL/min per 1.73 m2

No

Not performed

No

Kuznetsova, 2014, FLEMENGHO [86]

General

793 (51.5%)

51

4.8

Incidence of cardiac event (including HF):

1.8% in normal LV diastolic function group

9.2% in impaired relaxation group

18.6% in elevated filling pressure

e′ tissue doppler velocity

No

Not performed

Yes, independence not reported

Yang, 2016 [80]

At risk for HF

428 (52%)

70

1.2

12.4% developed HF symptoms or died

Age, Charlson comorbidity score, GLS, LA enlargement

No

Not performed

Yes, not independent

Shah, 2017, ARIC [87]

General population (also including HF patients)

6118 (58%)

75.3

1.8

0.8% in group with stage A HF

3.4% in group with stage B HF

Structural abnormalities, systolic dysfunction, diastolic dysfunction

No

Not performed, sex and age specific echocardiography cut-offs were used

Yes, independence not reported

Pugliese, 2020 [83]

General population (also including HF patients)

304 (35%)

66

1.5

Incidence of HF hospitalization: 4.4% in group with stage A HF

15% in group with stage B HF

Resting NT- proBNP > 900 pg/mL, peak VO2 < 16 mL/kg/min, VE/VCO2 slope ≥ 36, peak PAPs ≥ 50 mmHg, and Δ B-lines > 10

No

Not performed

No, not independent

Bobenko, 2020, DIAST-CHF [88]

At risk for HF

851 (44%)

66

10

Signs or symptoms of HF: 54% in those without elevated filling pressures and 65% in those with elevated filling pressures

Not investigated

No

Not performed

Yes, independence not reported

  1. Heart failure stages refer to the American College of Cardiology heart failure classification with stage A HF represents individuals at increased risk for HF without structural or functional heart abnormalities or heart failure signs or symptoms. Stage B represents individuals with structural abnormalities (such as abnormal diastolic function) in the absence of clinical signs and symptoms of HF. Stage C and D heart failure are marked by current or past evident heart failure signs and symptoms, accompanied by structural heart abnormalities
  2. Abbreviations: CAD, coronary artery disease; E/e′ ratio, the ratio of early mitral valve inflow (E) velocity divided by average e′; GFR, glomerular filtration rate; GLS, global longitudinal strain; HF, heart failure; LA, left atrium; LAVI, left atrial volume index; LV, left ventricle; LVDD, left ventricular diastolic dysfunction; NT-proBNP, N-terminal pro-brain natriuretic peptide; peak PAPs, peak systolic pulmonary artery pressure; VE/VCO2 slope, minute ventilation/carbon dioxide production slope; VO2 peak, peak oxygen consumption