Predisposing Risk Factors Affecting Reversibility of Left Ventricular Diastolic Dysfunction in Patients with Moderate Diastolic Dysfunction and Preserved Ejection Fraction

Introduction: Few data exist on factors affecting the reversibility of diastolic dysfunction (DD) especially in patients with preserved left ventricular ejection fraction (LVEF). Hypothesis: In the present study, we investigated the predisposing risk factors affecting the reversibility of DD in patients with moderate DD and preserved LVEF. Methods: A total of 600 patients with moderate DD and preserved LVEF who underwent follow-up echocardiography were enrolled between 2011 and 2020. We compared their index and follow-up echocardiography findings and determined the predisposing factor affecting the reversibility of DD. Results: Comparing the index and follow-up echocardiography findings showed that 379 (63%) patients had improved to normal or mild DD (improved group) and 221 (37%) patients had maintained or worsened DD (unimproved group). Among the clinical risk factors, the incidence of paroxysmal atrial fibrillation (PAF) was significantly higher in the unimproved group than in the improved group (11 vs. 18, p=0.007). After adjustment for other clinical factors, PAF was determined to be an independent predisposing risk factor for the unimproved group (odds ratio, 2.76; 95% CI: 1.28-6.21, p=0.01). At follow-up echocardiography, the mean E/A ratio and E/e' were significantly improved in patients without PAF but remained in patients with PAF. Conclusions: We identified that PAF was an independent predisposing risk factor for the unimproved group in patients with moderate DD and preserved LVEF. Therefore, further management of PAF might be required in patients with moderate DD and preserved LVEF to prevent adverse cardiovascular events.