Clinical correlates of isolated left ventricular diastolic dysfunction among hospitalized older heart failure patients.

Heart failure due to isolated left ventricular diastolic dysfunction (LVDD) is common among older adults. The purpose of this study was to develop a model based on admission clinical features to predict isolated LVDD in older adults hospitalized with heart failure. The authors studied 394 Alabama Medicare beneficiaries discharged with a primary discharge diagnosis of heart failure. All patients had data on LV function determined by echocardiography performed during the index hospitalization. Isolated LVDD was defined by LV ejection fraction >/=45% or LV function described as normal. The authors used all subsets multiple logistic regression analyses to examine various models predicting isolated LVDD. Patients had a mean (+/-SD) age of 78 (+/-7) years and 58% were women. One hundred thirty nine (35%) patients had isolated LVDD. More women (47%) than men (21%) had isolated LVDD (p<0.001). Variables independently associated with isolated LVDD in the selected 12-predictor model were female sex (odds ratio [OR]=3.10; 95% confidence interval [CI]=1.86-5.15), pulse 100 beats/min or greater (OR=0.43; 95% CI=0.25-0.72), systolic blood pressure (OR=1.01; 95% CI=1.00-1.02), diastolic blood pressure (OR=0.98; 95% CI=0.96-0.99), pulmonary vascular congestion by chest x-ray (OR=0.51; 95% CI=0.30-0.88), coronary artery disease (OR=0.54; 95% CI=0.32-0.92), cardiomyopathy (OR=0.21; 95% CI=0.10-0.47), and admission to a teaching hospital (OR=0.36; 95% CI=0.15-0.88). The authors concluded that the proportion of patients with isolated LVDD among this cohort of elderly hospitalized heart failure patients was low and was associated with few clinical characteristics. Except for female sex and systolic blood pressure, all model variables were negatively associated with isolated LVDD.