Introduction
Methods
Study setting
Anthropometric measurements, clinical, and laboratory data
Echocardiographic data
Classification of diastolic function and HFpEF
Peripheral arteries and abdominal aorta
Statistical analysis
Results
Baseline characteristics
Normal diastolic function | ALVDD (DD without HFpEF) | DDwHFpEF (DD with HFpEF) | p value | |
---|---|---|---|---|
n (%) | 5160 (87.3) | 678 (11.5) | 75 (1.3) | |
Demographics | ||||
Age, years | 60.0 [54.0, 67.0] | 67.0 [61.0, 72.0] | 71.0 [66.5, 73.0] | < 0.001 |
Female | 2642 (51.2) | 344 (50.7) | 46 (61.3) | 0.209 |
Ethnicity | 0.173 | |||
White | 5045 (97.8) | 662 (97.6) | 74 (98.7) | |
Black | 20 (0.4) | 4 (0.6) | 1 (1.3) | |
Asian | 33 (0.6) | 9 (1.3) | 0 (0.0) | |
Other | 62 (1.2) | 3 (0.5) | 0 (0.0) | |
BMI, kg/m2 | 25.7 [23.3, 28.6] | 26.8 [24.3, 29.7] | 27.9 [25.2, 31.9] | < 0.001 |
Current skmoker | 1055 (20.6) | 140 (20.8) | 19 (25.3) | 0.596 |
Education short** | 2602 (52.9) | 378 (59.1) | 50 (71.4) | < 0.001 |
Physical scales*** | 53.1 [47.6, 56.7] | 52.6 [46.6, 56.3] | 43.1 [35.3, 51.6] | < 0.001 |
Mental scales*** | 57.2 [51.1, 58.5] | 57.4 [52.6, 58.8] | 56.5 [48.5, 57.8] | 0.011 |
Quality of life*** | 0.9 [0.9, 1.0] | 0.9 [0.9, 1.0] | 0.9 [0.8, 0.9] | < 0.001 |
Comorbidities | ||||
Hypertension | 2882 (59.1) | 529 (79.9) | 69 (93.2) | < 0.001 |
Diabetes | 300 (6.3) | 72 (11.2) | 20 (28.6) | < 0.001 |
Allergies | 1885 (41.9) | 231 (39.7) | 28 (45.2) | 0.511 |
Coronary artery disease | 208 (5.5) | 51 (10.2) | 24 (47.1) | < 0.001 |
Atrial fibrillation | 144 (2.8) | 33 (4.9) | 12 (16.9) | < 0.001 |
COPD | 297 (6.3) | 38 (6.1) | 20 (31.7) | < 0.001 |
OSAS | 229 (4.8) | 47 (7.5) | 13 (19.1) | < 0.001 |
Peripheral artery disease | 118 (2.5) | 24 (3.9) | 6 ( 8.8) | 0.001 |
Chronic venous insufficiency | 134 (4.6) | 27 (6.9) | 4 (11.1) | 0.038 |
Dyspnoea | 370 (7.9) | 42 (6.7) | 56 (78.9) | < 0.001 |
Oedema | 28 (1.0) | 3 (0.8) | 4 (11.1) | < 0.001 |
Biological data + medication | ||||
Timed up and go Time, s | 7.0 [6.0, 8.0] | 7.0 [6.0, 8.0] | 8.0 [7.0, 10.0] | < 0.001 |
Ankle-branchial index | 1.1 [1.0, 1.2] | 1.0 [1.0, 1.1] | 1.1 [1.0, 1.1] | 0.021 |
Intima-media-thickness | 0.7 [0.7, 0.8] | 0.8 [0.7, 0.9] | 0.8 [0.8, 0.9] | < 0.001 |
ICA peak systolic velocity, m/s | 96.2 [81.6, 113.8] | 95.3 [82.9, 111.3] | 98.3 [84.7, 112.1] | 0.704 |
Abdominal aorta diameter, mm | 17.7 [16.1, 19.5] | 18.1 [16.0, 20.1] | 17.4 [15.9, 19.5] | 0.018 |
Aldosterone antagonists | 18 (0.4) | 3 (0.5) | 3 (4.2) | < 0.001 |
Loop diuretics | 55 (1.1) | 11 (1.7) | 8 (11.3) | < 0.001 |
Betablocker | 591 (12.0) | 136 (20.7) | 39 (54.9) | < 0.001 |
ACEi/ARBs | 868 (17.7) | 180 (27.4) | 32 (45.1) | < 0.001 |
Laboratories | ||||
LDL, mg/dl | 122.0 [98.0, 146.0] | 121.0 [94.0, 146.0] | 103.0 [81.0, 138.0] | 0.022 |
GFR, ml/min | 85.7 [75.5, 95.0] | 85.0 [74.0, 94.0] | 74.7 [62.8, 84.8] | < 0.001 |
NT-proBNP, ng/l | 68.0 [39.0, 114.0] | 78.0 [50.0, 116.5] | 233.0 [175.5, 379.5] | < 0.001 |
hsCRP, mg/dl | 0.1 [0.1, 0.2] | 0.1 [0.1, 0.3] | 0.2 [0.1, 0.5] | < 0.001 |
TSH, U/l | 1.2 [0.8, 1.7] | 1.1 [0.8, 1.6] | 1.1 [0.7, 1.6] | 0.296 |
Hemoglobin, g/dl | 14.3 [13.6, 15.1] | 14.4 [13.7, 15.1] | 13.9 [13.2, 14.6] | 0.004 |
HbA1c, % | 5.5 [5.3, 5.7] | 5.6 [5.4, 5.9] | 5.7 [5.4, 6.3] | < 0.001 |
Normal diastolic function | ALVDD (DD without HFpEF) | DDwHFpEF (DD with HFpEF) | p value | |
---|---|---|---|---|
n (%) | 5160 (87.3) | 678 (11.5) | 75 (1.3) | |
ECG data | ||||
PR, ms | 160.0 [146.0, 178.0] | 166.0 [153.0, 182.0] | 176.0 [150.0, 192.0] | < 0.001 |
QRS, ms | 92.0 [86.0, 98.0] | 92.0 [86.0, 100.0] | 94.0 [88.0, 104.0] | 0.005 |
QTc, ms | 418.0 [405.0, 432.0] | 423.0 [408.0, 438.0] | 431.0 [417.0, 445.0] | < 0.001 |
Hemiblock | 171 (3.7) | 23 (3.8) | 8 (11.6) | 0.003 |
AV-block | 233 (5.0) | 50 (8.3) | 13 (18.8) | < 0.001 |
Echocardiographic data | ||||
LVEF, % | 59.0 [56.4, 62.2] | 58.4 [56.0, 61.4] | 58.5 [55.8, 61.0] | 0.001 |
LV mass index, g/m2 | 79.9 [69.8, 92.5] | 87.9 [76.2, 104.4] | 94.6 [80.8, 115.6] | < 0.001 |
LVEDV, ml | 108.4 [90.8, 130.1] | 116.3 [94.4, 137.3] | 109.2 [88.4, 143.0] | < 0.001 |
LV lateral eʹ, cm/s | 10.8 [9.0, 12.8] | 7.9 [6.6, 9.0] | 7.7 [6.4, 9.5] | < 0.001 |
LV septal eʹ, cm/s | 8.8 [7.5, 10.4] | 6.7 [5.8, 7.8] | 6.2 [5.5, 7.2] | < 0.001 |
E/eʹ mean ratio | 7.0 [6.0, 8.1] | 10.4 [8.6, 11.3] | 11.1 [9.3, 12.4] | < 0.001 |
E/A ratio | 1.0 [0.8, 1.2] | 0.9 [0.7, 1.0] | 0.8 [0.7, 1.0] | < 0.001 |
TR Vmax, m/s | 2.1 [1.9, 2.3] | 2.2 [1.9, 2.4] | 2.3 [2.0, 2.5] | < 0.001 |
TAPSE, mm | 2.4 [2.2, 2.7] | 2.4 [2.2, 2.7] | 2.3 [1.9, 2.6] | 0.066 |
RV sʹ, cm/s | 0.1 [0.1, 0.2] | 0.1 [0.1, 0.2] | 0.1 [0.1, 0.2] | 0.101 |
LASV, ml | 25.2 [21.2, 29.5] | 34.1 [24.5, 37.8] | 35.1 [27.9, 40.1] | < 0.001 |
Correlates of ALVDD and DDwHFpEF
ALVDD (DD without HFpEF) | DDwHFpEF (DD with HFpEF) | |||
---|---|---|---|---|
OR (95% CI) | p value | OR (95% CI) | p value | |
Demographics | ||||
Age | 1.7 (1.5–1.9) | < 0.001 | 2.7 (1.8–4.3) | < 0.001 |
Female | 1.2 (1.0–1.4) | 0.141 | 2.5 (1.3–4.9) | 0.006 |
BMI | 1.2 (1.1–1.3) | < 0.001 | 1.6 (1.2–2.1) | 0.001 |
Current skmoker | 1.3 (1.0–1.7) | 0.055 | 2.1 (1.0–4.4) | 0.051 |
Education short** | 1.1 (0.9–1.3) | 0.506 | 1.2 (0.6–2.4) | 0.646 |
Physical scales*** | 1.0 (0.9–1.2) | 0.611 | 0.7 (0.5–0.9) | 0.002 |
Mental scales*** | 1.0 (0.9–1.1) | 0.971 | 0.8 (0.6–1.1) | 0.1 |
Quality of life*** | 1.0 (0.9–1.1) | 0.993 | 0.8 (0.7–1.0) | 0.063 |
Comorbidities | ||||
Hypertension | 2.0 (1.5–2.6) | < 0.001 | 2.8 (0.9–12.0) | 0.101 |
Diabetes | 1.2 (0.8–1.6) | 0.383 | 1.7 (0.8–3.6) | 0.165 |
Allergies | 1.0 (0.8–1.3) | 0.807 | 1.2 (0.6–2.3) | 0.69 |
Coronary artery disease | 1.1 (0.8–1.5) | 0.595 | 7.2 (3.6–14.2) | < 0.001 |
Atrial fibrillation | 0.9 (0.6–1.5) | 0.769 | 2.6 (1.1–5.9) | 0.024 |
COPD | 0.6 (0.4–1.0) | 0.049 | 3.9 (1.8–8.0) | < 0.001 |
OSAS | 1.3 (0.8–1.9) | 0.275 | 1.5 (0.5–3.8) | 0.395 |
Peripheral artery disease | 1.5 (0.9–2.5) | 0.111 | 0.5 (0.1–1.9) | 0.396 |
Chronic venous insufficiency | 0.8 (0.4–1.3) | 0.342 | 0.9 (0.1–3.3) | 0.867 |
Biological data + medication | ||||
Timed up and go Time | 0.9 (0.8–1.1) | 0.397 | 1.3 (0.9–1.7) | 0.144 |
Ankle-branchial index | 0.9 (0.8–1.1) | 0.348 | 1.2 (0.8–2.1) | 0.419 |
Intima-media-thickness | 1.0 (0.9–1.2) | 0.517 | 1.2 (0.9–1.5) | 0.24 |
ICA peak systolic velocity | 1.0 (0.9–1.1) | 0.936 | 1.0 (0.7–1.4) | 0.985 |
Abdominal aorta diameter | 1.1 (1.0–1.2) | 0.01 | 0.9 (0.7–1.2) | 0.534 |
Laboratories | ||||
LDL | 1.0 (0.9–1.1) | 0.574 | 0.9 (0.7–1.3) | 0.73 |
GFR | 1.2 (1.1–1.4) | < 0.001 | 1.0 (0.7–1.3) | 0.781 |
hsCRP | 1.0 (0.9–1.1) | 0.932 | 1.2 (0.9–1.3) | 0.079 |
TSH | 1.0 (0.9–1.1) | 0.843 | 1.0 (0.7–1.2) | 0.932 |
Hemoglobin | 1.0 (0.9–1.1) | 0.827 | 0.9 (0.6–1.2) | 0.415 |
HbA1 | 1.2 (1.0–1.3) | 0.007 | 0.9 (0.7–1.3) | 0.759 |
ECG data | ||||
PR | 1.1 (1.0–1.3) | 0.013 | 1.0 (0.7–1.2) | 0.75 |
QRS | 1.0 (0.9–1.1) | 0.459 | 1.4 (1.1–1.7) | 0.005 |
QTc | 1.0 (0.8–1.1) | 0.847 | 1.0 (0.7–1.1) | 0.758 |
Hemiblock | 0.6 (0.4–1.1) | 0.109 | 1.4 (0.4–3.8) | 0.568 |
AV-block | 1.1 (0.7–1.6) | 0.778 | 1.6 (0.6–3.9) | 0.346 |
Echocardiographic data | ||||
LVEF | 0.9 (0.8–1.0) | 0.077 | 1.0 (0.7–1.3) | 0.824 |
LV mass index | 1.5 (1.4–1.7) | < 0.001 | 1.9 (1.4–2.5) | < 0.001 |
LVEDV | 1.7 (1.5–1.9) | < 0.001 | 2.0 (1.3–2.9) | < 0.001 |
LV lateral eʹ | 0.3 (0.2–0.3) | < 0.001 | 0.5 (0.3–0.7) | 0.001 |
LV septal eʹ | 0.3 (0.2–0.3) | < 0.001 | 0.3 (0.2–0.5) | < 0.001 |
E/eʹ mean ratio | 5.3 (4.6–6.2) | < 0.001 | 2.4 (1.9–3.1) | < 0.001 |
E/A ratio | 0.9 (0.8–1.1) | 0.318 | 1.1 (0.8–1.5) | 0.525 |
TR Vmax | 1.0 (0.9–1.1) | 0.913 | 1.2 (0.8–1.8) | 0.429 |
TAPSE | 1.0 (0.9–1.1) | 0.833 | 0.9 (0.6–1.3) | 0.636 |
RV sʹ | 0.9 (0.8–1.0) | 0.251 | 0.9 (0.7–1.2) | 0.648 |
LASV | 2.2 (2.0–2.5) | < 0.001 | 2.1 (1.6–2.7) | < 0.001 |