Few Patients With Diastolic Dysfunction Progress to HFpEF
In a 4.3-year follow-up study, few asymptomatic patients with preclinical left ventricular diastolic dysfunction (LVDD) progressed to heart failure with preserved ejection fraction (HFpEF), with a higher incidence noted in women. High blood pressure and decreased kidney function were associated with elevated levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP).
METHODOLOGY:
The progression of LVDD may lead to the development of HFpEF over time. Despite the similar prevalence of LVDD in both sexes, HFpEF is more common in women than in men.
Researchers evaluated longitudinal changes in markers of LVDD severity and HFpEF in men and women from a cohort of individuals who were at a high cardiovascular risk.
They included 146 individuals with preclinical LVDD and no symptoms of HF at baseline (mean age, 63 years; 58% women) and reassessed them after a median follow-up duration of 4.3 years.
Follow-up measurements included blood pressure, biomarkers such as NT-proBNP, kidney function, and echocardiography.
HFpEF was assessed on the basis of signs, symptoms, and echocardiographic abnormalities. An LV ejection fraction below 50% was considered HF with reduced ejection fraction.
TAKEAWAY:
Overall, 10% of individuals developed HF, with 13 classified as those with HFpEF (nine women and four men). The annual incidence of HFpEF was 2%.
Median NT-proBNP plasma levels increased from 71 to 100 pg/mL over the follow-up period. A significant rise was observed in terms of the presence of major functional abnormalities in both men and women and the presence of major morphologic abnormalities in women ( P for sex interaction = .03).
for sex interaction = .03). Each SD decrease in the estimated glomerular filtration rate resulted in higher NT-proBNP levels in men and women (beta for change over time, 0.12; 95% CI, 0.01-0.22).
Overall, a rise in systolic or diastolic BP led to an increase in NT-proBNP levels over time, with a higher systolic BP in women and a higher diastolic BP in men associated with an increase in NT-proBNP levels.
IN PRACTICE:
"High blood pressure and decreased kidney function were associated with higher levels of NT-proBNP. This highlights the need to further explore cardiorenal protection as a method to prevent HFpEF," the authors of the study wrote.
SOURCE:
This study was led by Anne Margje Lisa Naomi van Ommen, Utrecht University, Utrecht, the Netherlands. It was published online on May 04, 2025, in Open Heart .
LIMITATIONS:
The moderate sample size resulted in insufficient power to draw definitive conclusions about sex differences. A potential risk for measurement biases existed. The relatively low prevalence of comorbidities and the potential selection bias towards healthier individuals may have limited the generalisability of the findings.
DISCLOSURES:
This study received financial support from the Dutch CardioVascular Alliance, supported by the Dutch Heart Foundation. The authors declared having no competing interests.
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