Ricardo Ladeiras-Lopes1, Margarida Araújo2, Francisco Sampaio3, Adelino Leite-Moreira4, Ricardo Fontes-Carvalho5. 1. Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: ricardoladeiraslopes@gmail.com. 2. Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal. 3. Cardiology Department, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal. 4. Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal. 5. Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal; Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal.
Abstract
INTRODUCTION: Diastolic dysfunction is highly prevalent and a key pathophysiological contributor to several cardiovascular diseases, especially heart failure with preserved ejection fraction. In addition, some evidence suggests diastolic dysfunction is a risk factor for major adverse cardiovascular events. This study aimed to systematically review the evidence and to quantify the association between diastolic dysfunction and risk of cardiovascular events and death. METHODS: MEDLINE was systematically searched from 1974 up to October 2017. We included cohort studies that assessed diastolic function in adults in the community, providing a definition of diastolic dysfunction regarding the occurrence of any cardiovascular event or mortality. For the quantitative analysis, relative risk estimates comparing individuals with versus without diastolic dysfunction were combined using a random effects model. RESULTS: Nineteen studies were identified for inclusion in the systematic review, assessing a total of 63 802 participants. Nine studies were included in the meta-analysis. Diagnostic criteria and classification of diastolic dysfunction differed substantially between studies. The median prevalence of diastolic dysfunction in studies including individuals with and without diastolic dysfunction was 35.1% (range 5.3-65.2%). Comparing diastolic dysfunction with normal diastolic function, the summary relative risk estimate for cardiovascular events or mortality was 3.53 (95% CI: 2.75-4.53; I2=85.5%; nine studies). CONCLUSIONS: Although the definitions found in the literature differ, the diagnosis of diastolic dysfunction is associated with a 3.53-fold increased risk of cardiovascular events or death. This finding highlights the importance of developing easily applicable and consensual diagnostic criteria, as well as fostering research on effective treatment strategies when diastolic dysfunction is identified in the subclinical stage.
INTRODUCTION:Diastolic dysfunction is highly prevalent and a key pathophysiological contributor to several cardiovascular diseases, especially heart failure with preserved ejection fraction. In addition, some evidence suggests diastolic dysfunction is a risk factor for major adverse cardiovascular events. This study aimed to systematically review the evidence and to quantify the association between diastolic dysfunction and risk of cardiovascular events and death. METHODS: MEDLINE was systematically searched from 1974 up to October 2017. We included cohort studies that assessed diastolic function in adults in the community, providing a definition of diastolic dysfunction regarding the occurrence of any cardiovascular event or mortality. For the quantitative analysis, relative risk estimates comparing individuals with versus without diastolic dysfunction were combined using a random effects model. RESULTS: Nineteen studies were identified for inclusion in the systematic review, assessing a total of 63 802 participants. Nine studies were included in the meta-analysis. Diagnostic criteria and classification of diastolic dysfunction differed substantially between studies. The median prevalence of diastolic dysfunction in studies including individuals with and without diastolic dysfunction was 35.1% (range 5.3-65.2%). Comparing diastolic dysfunction with normal diastolic function, the summary relative risk estimate for cardiovascular events or mortality was 3.53 (95% CI: 2.75-4.53; I2=85.5%; nine studies). CONCLUSIONS: Although the definitions found in the literature differ, the diagnosis of diastolic dysfunction is associated with a 3.53-fold increased risk of cardiovascular events or death. This finding highlights the importance of developing easily applicable and consensual diagnostic criteria, as well as fostering research on effective treatment strategies when diastolic dysfunction is identified in the subclinical stage.
Authors: Marjola Thanaj; Johanna Mielke; Kathryn A McGurk; Wenjia Bai; Nicolò Savioli; Antonio de Marvao; Hannah V Meyer; Lingyao Zeng; Florian Sohler; R Thomas Lumbers; Martin R Wilkins; James S Ware; Christian Bender; Daniel Rueckert; Aidan MacNamara; Daniel F Freitag; Declan P O'Regan Journal: Nat Cardiovasc Res Date: 2022-04-13