Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited

Background: Diastolic dysfunction (DD) has shown to be a hallmark pathological intermediate in the development of heart failure with preserved ejection fraction (HFpEF). We aim to establish age- and sex-stratified normal reference values of diastolic indices and to explore racial-differences. Method...

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Autores principales:	Sheng-Nan Chang, Kuo-Tzu Sung, Wen-Hung Huang, Jou-Wei Lin, Shih-Chieh Chien, Ta-Chuan Hung, Cheng-Huang Su, Chung-Lieh Hung, Chia-Ti Tsai, Yen-Wen Wu, Fu-Tien Chiang, Hung-I Yeh, Juey-Jen Hwang
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	American Society of echocardiography (ASE) Diastolic dysfunction (DD) Ethnic asians Heart failure (HF) N-terminal pro-brain natriuretic peptide (NT-proBNP) Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/b802b3a534864c82a5b6154e2af61cfc
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spelling	oai:doaj.org-article:b802b3a534864c82a5b6154e2af61cfc2021-12-02T04:59:09ZSex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited0929-664610.1016/j.jfma.2020.12.024https://doaj.org/article/b802b3a534864c82a5b6154e2af61cfc2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S0929664620306240https://doaj.org/toc/0929-6646Background: Diastolic dysfunction (DD) has shown to be a hallmark pathological intermediate in the development of heart failure with preserved ejection fraction (HFpEF). We aim to establish age- and sex-stratified normal reference values of diastolic indices and to explore racial-differences. Methods: We explored age- and sex-related structural/functional alterations from 6023 healthy ethnic Asians (47.1 ± 10.9 years, 61.3% men) according to 2016 American Society of Echocardiography (ASE) diastolic dysfunction (DD) criteria. Racial comparisons were made using data from London Life Sciences Prospective Population (LOLIPOP) study. Results: Age- and sex-based normative ranges (including mean, median, 10% and 90% lower and upper reference values) were extracted from our large healthy population. In fully adjusted models, advanced age was independently associated with cardiac structural remodeling and worsened diastolic parameters including larger indexed LA volume (LAVi), lower e’, higher E/e’, and higher TR velocity; all p < 0.001), which were more prominent in women (P interaction: <0.05). Broadly, markedly lower e’, higher E/e’ and smaller LAVi were observed in ethnic Asians compared to Whites. DD defined by 2016 ASE criteria, despite at low prevalence (0.42%) in current healthy population, increased drastically with advanced age and performed perfectly in excluding abnormal NT-proBNP (≥125 pg/mL) (Specificity: 99.8%, NPV: 97.6%). Conclusion: This is to date the largest cohort exploring the normative reference values using guideline-centered diastolic parameters from healthy Asians, with aging played as central role in diastolic dysfunction. Our observed sex and ethnic differences in defining healthy diastolic cut-offs likely impact future clinical definition for DD in Asians.Sheng-Nan ChangKuo-Tzu SungWen-Hung HuangJou-Wei LinShih-Chieh ChienTa-Chuan HungCheng-Huang SuChung-Lieh HungChia-Ti TsaiYen-Wen WuFu-Tien ChiangHung-I YehJuey-Jen HwangElsevierarticleAmerican Society of echocardiography (ASE)Diastolic dysfunction (DD)Ethnic asiansHeart failure (HF)N-terminal pro-brain natriuretic peptide (NT-proBNP)Medicine (General)R5-920ENJournal of the Formosan Medical Association, Vol 120, Iss 12, Pp 2160-2175 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	American Society of echocardiography (ASE) Diastolic dysfunction (DD) Ethnic asians Heart failure (HF) N-terminal pro-brain natriuretic peptide (NT-proBNP) Medicine (General) R5-920
spellingShingle	American Society of echocardiography (ASE) Diastolic dysfunction (DD) Ethnic asians Heart failure (HF) N-terminal pro-brain natriuretic peptide (NT-proBNP) Medicine (General) R5-920 Sheng-Nan Chang Kuo-Tzu Sung Wen-Hung Huang Jou-Wei Lin Shih-Chieh Chien Ta-Chuan Hung Cheng-Huang Su Chung-Lieh Hung Chia-Ti Tsai Yen-Wen Wu Fu-Tien Chiang Hung-I Yeh Juey-Jen Hwang Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited
description	Background: Diastolic dysfunction (DD) has shown to be a hallmark pathological intermediate in the development of heart failure with preserved ejection fraction (HFpEF). We aim to establish age- and sex-stratified normal reference values of diastolic indices and to explore racial-differences. Methods: We explored age- and sex-related structural/functional alterations from 6023 healthy ethnic Asians (47.1 ± 10.9 years, 61.3% men) according to 2016 American Society of Echocardiography (ASE) diastolic dysfunction (DD) criteria. Racial comparisons were made using data from London Life Sciences Prospective Population (LOLIPOP) study. Results: Age- and sex-based normative ranges (including mean, median, 10% and 90% lower and upper reference values) were extracted from our large healthy population. In fully adjusted models, advanced age was independently associated with cardiac structural remodeling and worsened diastolic parameters including larger indexed LA volume (LAVi), lower e’, higher E/e’, and higher TR velocity; all p < 0.001), which were more prominent in women (P interaction: <0.05). Broadly, markedly lower e’, higher E/e’ and smaller LAVi were observed in ethnic Asians compared to Whites. DD defined by 2016 ASE criteria, despite at low prevalence (0.42%) in current healthy population, increased drastically with advanced age and performed perfectly in excluding abnormal NT-proBNP (≥125 pg/mL) (Specificity: 99.8%, NPV: 97.6%). Conclusion: This is to date the largest cohort exploring the normative reference values using guideline-centered diastolic parameters from healthy Asians, with aging played as central role in diastolic dysfunction. Our observed sex and ethnic differences in defining healthy diastolic cut-offs likely impact future clinical definition for DD in Asians.
format	article
author	Sheng-Nan Chang Kuo-Tzu Sung Wen-Hung Huang Jou-Wei Lin Shih-Chieh Chien Ta-Chuan Hung Cheng-Huang Su Chung-Lieh Hung Chia-Ti Tsai Yen-Wen Wu Fu-Tien Chiang Hung-I Yeh Juey-Jen Hwang
author_facet	Sheng-Nan Chang Kuo-Tzu Sung Wen-Hung Huang Jou-Wei Lin Shih-Chieh Chien Ta-Chuan Hung Cheng-Huang Su Chung-Lieh Hung Chia-Ti Tsai Yen-Wen Wu Fu-Tien Chiang Hung-I Yeh Juey-Jen Hwang
author_sort	Sheng-Nan Chang
title	Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited
title_short	Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited
title_full	Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited
title_fullStr	Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited
title_full_unstemmed	Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited
title_sort	sex, racial differences and healthy aging in normative reference ranges on diastolic function in ethnic asians: 2016 ase guideline revisited
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/b802b3a534864c82a5b6154e2af61cfc
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Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited

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