Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction

Abstract

Exercise capacity and quality of life (QOL) are important outcome predictors in patients with systolic heart failure (HF), independent of left ventricular (LV) ejection fraction (LVEF). LV diastolic function has been shown to be a better predictor of aerobic exercise capacity in patients with systolic dysfunction and a New York Heart Association (NYHA) classification ≥II. We hypothesized that the currently used index of diastolic function E/e' is associated with exercise capacity and QOL, even in optimally treated HF patients with reduced LVEF. This prospective study included 44 consecutive patients aged 55±11 years (27 men and 17 women), with LVEF<0.50 and NYHA functional class I-III, receiving optimal pharmacological treatment and in a stable clinical condition, as shown by the absence of dyspnea exacerbation for at least 3 months. All patients had conventional transthoracic echocardiography and answered the Minnesota Living with HF Questionnaire, followed by the 6-min walk test (6MWT). In a multivariable model with 6MWT as the dependent variable, age and E/e' explained 27% of the walked distance in 6MWT (P=0.002; multivariate regression analysis). No association was found between walk distance and LVEF or mitral annulus systolic velocity. Only normalized left atrium volume, a sensitive index of diastolic function, was associated with decreased QOL. Despite the small number of patients included, this study offers evidence that diastolic function is associated with physical capacity and QOL and should be considered along with ejection fraction in patients with compensated systolic HF.

Association between left ventricular global longitudinal strain, health‐related quality of life and functional capacity in chronic kidney disease patients with preserved ejection fraction

“…While QOL is recognized as a worthy ‘end point’ of CKD, there are limited reports on the relationship between cardiac function and QOL. Indices of diastolic function, but not systolic function were shown to be associated with decreased QOL scores in patients with stable HF . This study found an independent association between GLS and MCS, but surprisingly not with PCS.…”

“…Functional capacity and health‐related quality of life (QOL) have important prognostic implications in HF. Previous evidence suggests that diastolic function rather than EF is associated with reduced functional capacity and QOL . Alteration of LV filling pressure and diastolic volumes can result in reduction in cardiac output and closely correlates with exercise performance and effort tolerance .…”

Resveratrol Treatment of Mice With Pressure-Overload–Induced Heart Failure Improves Diastolic Function and Cardiac Energy Metabolism

“…Interestingly, studies of patients with HF have shown that the degree of diastolic dysfunction and not EF influenced survival rate, suggesting that diastolic dysfunction is an important contributor to HF independent of EF. 41,42 Furthermore, mounting evidence also indicates that LA enlargement is associated with a poorer prognosis and is a powerful predictor of outcomes in patients with HF with reduced EF providing additional prognostic information independent from systolic and diastolic function. 15 Together, this supports that resveratrol improves survival rates in mice with established HF, in part, by improving diastolic function and reducing LA enlargement.…”

A comparative analysis of British and American Society of Echocardiography recommendations for the assessment of left ventricular diastolic function

“…The clinical manifestation of LVDF is variable and includes fatigue secondary to reduction in cardiac output and exertional dyspnoea. Symptoms associated with LVDF are often caused by pulmonary vein retrograde flow attributed to elevated end-diastolic pressures, which can have a profound impact on quality of life (2). A systematic review performed by van Riet and colleagues (3) concluded that the prevalence of diastolic dysfunction is high in patients aged over 60 years within the western general population with a median prevalence of 36%.…”