Author + information
- Ricardo Fontes-Carvalho, MD∗ (, )
- Ana Azevedo, MD, PhD and
- Adelino Leite-Moreira, MD, PhD
- ↵∗Faculty of Medicine, University of Porto, Al. Prof. Hernani Monteiro, 4200-319 Porto, Portugal
We read with great interest the paper by Kuwaki et al. (1) describing a new grade of diastolic function and its association with major adverse cardiovascular events. The study is also noteworthy because the authors performed speckle-tracking analysis of the left atrium, giving an additional emphasis on the interrelation between diastolic function and left atrium mechanics. In their study, Kuwaki et al. (1) determined diastolic dysfunction grades in patients referred for echocardiography in a tertiary care center. We sought to evaluate the prevalence of this new grade of diastolic function at the general-population level.
In this study, we analyzed data from individuals within the first follow-up of a cohort representative, at baseline, of a European adult population from Porto, Portugal—the EPIPorto cohort study. All patients were prospectively evaluated with a clinical interview, detailed echocardiography, and blood testing. Patients with coronary artery disease, percutaneous or surgical revascularization, prior cardiac surgery, or significant valvular heart disease were excluded from this analysis. A total of 1,038 individuals age ≥45 years (62% female; mean age: 62.4 ± 10.6 years) were evaluated for the determination of diastolic dysfunction grades, applying the same criteria used by Kuwaki et al (1).
In this sample from the general population, we found that the new Ia grade of diastolic dysfunction was present in only 53 individuals (5.1%), which is 3 times less frequent than the prevalence observed by Kuwaki et al. (17.9%). In our population, most of the patients had normal diastolic function (56.3%) compared with only 35.5% in the study by Kuwaki et al. Grade I diastolic dysfunction was found in 21.1% (n = 219); grade II in 9.5% (n = 99); and grade III in 0.2% (n = 2). In 67 patients (6.4%), no grade was endorsed. The main differences in the prevalence of diastolic dysfunction may be attributable to the high prevalences of cardiovascular disease (21%) and of cancer (25%) in the study by Kuwaki et al. (1). A limitation of their study was the high prevalence (19.3%) of mitral annular calcification in the group with grade Ia, because in these patients the annular velocity measurements and the E/ε′ ratio should be interpreted with extreme caution (2).
In our population, we observed that compared with grade I diastolic dysfunction, individuals with the new grade Ia diastolic dysfunction were older (age 72.7 ± 8.1 years vs. 67.9 ± 9.1 years; p = 0.001), had higher systolic blood pressure (150.2 ± 25.6 mm Hg vs. 142.1 ± 20.2 mm Hg; p = 0.01), and had greater left ventricular mass (p = 0.004). On the other hand, when we compared patients with the new grade Ia diastolic dysfunction with those with grade II diastolic dysfunction, we found a significant difference only in age (72.7 ± 8.1 years vs. 68.3 ± 8.5 years; p = 0.002).
These data also emphasize the difficulty in the classification of diastolic grades in some patients. Sometimes parameters are conflicting, and there is variation between observers and according to the population studied. Nonetheless, in everyday clinical practice, the determination of the E/ε′ ratio should be routine. It has some limitations, but it is easy to calculate, is reproducible, and provides prognostic information in several cardiovascular diseases (2). Finally, in the same way that the evaluation of systolic function should go far beyond the calculation of ejection fraction, the E/ε′ ratio should not be “the be-all and end-all of diastology” (3).
- American College of Cardiology Foundation
- Kuwaki H.,
- Takeuchi M.,
- Wu V.C.,
- et al.
- Tajik A.J.,
- Jan M.F.