Prevalence of left ventricular diastolic dysfunction in European populations based on cross-validated diagnostic thresholds

We measured the E and A peaks of transmitral blood flow by pulsed wave Doppler and the e' and a' peaks of mitral annular velocities by tissue Doppler imaging (TDI) in 2 cohorts randomly recruited in Belgium (n = 782; 51.4% women; mean age, 51.1 years) and in Italy, Poland and Russia (n = 476; 55.7%; 44.5 years).In stepwise regression, the multivariable-adjusted correlates of the transmitral and TDI diastolic indexes were similar in the 2 cohorts and included sex, age, body mass index, blood pressure and heart rate. Similarly, cut-off limits for the E/A ratio (2.5th percentile) and E/e' ratio (97.5th percentile) in 338 and 185 reference subjects free from cardiovascular risk factors respectively selected from both cohorts were consistent within 0.02 and 0.26 units (median across 5 age groups). The rounded 2.5th percentile of the E/A ratio decreased by ~0.10 per age decade in these apparently healthy subjects. The reference subsample provided age-specific cut-off limits for normal E/A and E/e' ratios. In the 2 cohorts combined, diastolic dysfunction groups 1 (impaired relaxation), 2 (possible elevated LV filling pressure) and 3 (elevated E/e' and abnormally low E/A) encompassed 114 (9.1%), 135 (10.7%), and 40 (3.2%) subjects, respectively.The age-specific criteria for diastolic LV dysfunction were highly consistent across the study populations with an age-standardized prevalence of 22.4% vs. 25.1%.Cardiovascular risk factors underlie the first stage of diastolic heart failure (HF). This stage evolves into asymptomatic left ventricular diastolic dysfunction (LVDD) characterized by impaired relaxation and increased left ventricular (LV) stiffness, and finally progresses to clinically overt diastolic HF [1]. Recently published community-based studies making use of conventional and tissue Doppler echocardiographic imaging (TDI) revealed a high prevalence of LVDD, ranging from 11.1% up to 34.7% [2-8]. In the Flemish Study on Environment, Genes and Health Outcomes (FLEMENGH