Longitudinal Changes in Left Ventricular Diastolic Function in Late Life: The ARIC Study

Background: There is limited data regarding longitudinal changes of diastolic function in the very old, who are at the highest risk for heart failure (HF). Objectives: This study aims to quantify intraindividual longitudinal changes of diastolic function over 6 years in late life. Methods: The authors studied 2,524 older adult participants in the prospective community-based ARIC (Atherosclerosis Risk In Communities) study who underwent protocol-based echocardiography at study visits 5 (2011-2013) and 7 (2018-2019). The primary diastolic measures were tissue Doppler e′, E/e′ ratio, and left atrial volume index (LAVI). Results: Mean age was 74 ± 4 years at visit 5 and 80 ± 4 at visit 7, 59% were women, and 24% were Black. At visit 5, mean e′_septal was 5.8 ± 1.4 cm/s, E/e′_septal 11.7 ± 3.5, and LAVI 24.3 ± 6.7 mL/m². Over a mean of 6.6 ± 0.8 years, e′_septal decreased by 0.6 ± 1.4 cm/s, E/e′_septal increased by 3.1 ± 4.4, and LAVI increased by 2.3 ± 6.4 mL/m². The proportion with 2 or more abnormal diastolic measures increased from 17% to 42% (P < 0.001). Compared with participants free of cardiovascular (CV) risk factors or diseases at visit 5 (n = 234), those with prevalent CV risk factors or diseases but without prevalent or incident HF (n = 2,150) demonstrated greater increases in E/e′_septal and LAVI. Increases of E/e′_septal and LAVI were both associated with the development of dyspnea between visits in analyses adjusted for CV risk factors. Conclusions: Diastolic function generally deteriorates over 6.6 years in late life, particularly among persons with CV risk factors, and is associated with development of dyspnea. Further studies are necessary to determine if risk factor prevention or control will mitigate these changes.