Risk factors for longitudinal changes in left ventricular diastolic function among women and men

Heart. 2019 Sep;105(18):1414-1422. doi: 10.1136/heartjnl-2018-314487. Epub 2019 Apr 1.


Objective: To evaluate changes in left ventricular diastolic function (LVDF) parameters and their associated risk factors over a period of 11 years among community-dwelling women and men.

Methods: Echocardiography was performed three times among 870 women and 630 men (age 67±3 years) from the prospective population-based Rotterdam Study during a period of 11-year follow-up. Changes in six continuous LVDF parameters were correlated with cardiovascular risk factors using a linear-mixed effect model (LMM).

Results: In women, smoking was associated with deleterious longitudinal changes in deceleration time (DT) (Beta (β): 7.73; 95% CI 2.56 to 12.9) and high-density lipoprotein cholesterol was associated with improvement of septal e' (β: 0.37; 95% CI 0.13 to 0.62) and E/e' ratio (β: -0.46; 95% CI -0.84 to -0.08) trajectories. Among men, diabetes was associated with deleterious longitudinal changes in A wave (β: 3.83; 95% CI 0.06 to 7.60), septal e' (β: -0.40; 95% CI -0.70 to -0.09) and E/e' ratio (β: 0.60; 95% CI 0.14 to 1.06) and body mass index was associated with deleterious longitudinal changes in A wave (β: 1.25; 95% CI 0.84 to 1.66), E/A ratio (β: -0.007; 95% CI -0.01 to -0.003), DT (β: 0.86; 95% CI 0.017 to 1.71) and E/e' ratio (β: 0.12; 95% CI 0.06 to 0.19).

Conclusions: Smoking among women and metabolic factors (diabetes mellitus and body mass index) among men showed larger deleterious associations with longitudinal changes in LVDF parameters. The favourable association of HDL was mainly observed among women. This study, for the first time, evaluates risk factors associated with changes over time in continuous LVDF parameters among women and men and generates new hypothesis for further medical research.

Keywords: cohort study; echocardiography, doppler; left ventricular diastolic function; risk factors; sex difference.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Diabetes Mellitus / epidemiology
  • Diastole
  • Dyslipidemias / epidemiology
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Obesity / epidemiology
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Time Factors
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / epidemiology
  • Ventricular Dysfunction, Left / physiopathology*
  • Ventricular Function, Left*