Aortic stiffening precedes onset of heart failure with preserved ejection fraction in patients with asymptomatic diastolic dysfunction

Background: Identifying which patients with diastolic dysfunction will progress to heart failure with preserved ejection fraction (HFpEF) remains challenging. The goal of this study is to determine whether increased vascular stiffness as identified on 2D transthoracic echocardiography (TTE) serves as a biomarker for the development of HFpEF in patients with diastolic dysfunction. Methods: The study design is a matched retrospective case-control study. Subjects with diastolic dysfunction were divided into two groups based on whether they had a clinical diagnosis of HFpEF. The two groups were matched based on age, gender, race and body surface area, resulting in 77 matched pairs (n = 154). Data from the first TTE that documented diastolic dysfunction prior to the development of HFpEF was extracted along with baseline demographic and clinical data. Indices of vascular stiffness were measured and compared. A sub-group analysis was performed to compare diabetic subjects in Group 1 (n = 43) to those in Group 2 ( n = 21). Results: Group 1 had significantly decreased aortic distensibility as measured on the initial TTE when compared to Group 2 (1.9 +/- 1.0 vs. 2.8 +/- 1.8 cm(2)dyne(-1)10(-3), p = 0.01). In the diabetic subset, Group 1 had significantly less aortic strain (6.9 +/- 3.3 vs. 9.7 +/- 5.6%, p = 0.02) and aortic distensibility (1.8 +/- 1.0 vs. 3.5 +/- 2.6 cm(2)dyne(-1)10(-3), p = 0.02) compared to Group 2. Other indices of vascular stiffness did not differ significantly between groups. Conclusions: This study demonstrates that increased proximal aortic stiffness is associated with the development of HFpEF in patients with asymptomatic diastolic dysfunction. Larger prospective studies are needed to further investigate this relationship.