Prevalence of left ventricular diastolic dysfunction and effect of obesity on left atrial strain in older adults of Geriatric department

doi:10.21203/rs.3.rs-4858845/v1

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Prevalence of left ventricular diastolic dysfunction and effect of obesity on left atrial strain in older adults of Geriatric department

https://doi.org/10.21203/rs.3.rs-4858845/v1

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Background

left ventricular diastolic dysfunction (LVDD) is an independent cardiovascular risk factor. Little is known about the prevalence of LVDD in the older adults, as well as the associated factors.

Objective: to determine the prevalence of LVDD in the elderly, the specific objectives were to characterize the population according to demographic, anthropometric, clinical and echocardiographic variables, to obtain the prevalence of degrees of LVDD and associated factors.

Methodology: it was an analytical cross-sectional study conducted in 158 adults aged ≥ 65 years who attended the geriatric department they underwent an echocardiogram, echocardiographic criteria for diastolic function were applied, patients with left ventricular ejection fraction less than 50%, pacemakers, resynchronizers or defibrillators were excluded.

Results: the prevalence of LVDD in the elderly was 20%. In patients aged ≥ 75 years, the prevalence ratio (PR) was 2.24 (95% CI 1.20–4.16) p = 0.010. The mean longitudinal strain of the left atrium (LA) was different with respect to body mass index (BMI) p = 0.003.

Conclusions: LVDD was associated with age and the probability increased in adults ≥ 75 years, the prevalence of LVVD was 20%, obesity is associated with impaired reservoir LA function. In older adults the obesity. These findings emphasize the need to perform an echocardiogram in adults ≥ 75 years for the detection and follow-up of the progression of cardiac dysfunction.

left ventricular diastolic dysfunction

older adult

associated factors

left atrium strain

Cardiac function is divided into systolic and diastolic, the systolic is the force of contraction of the ventricles whose decrease indicates heart failure and has an impact on the prognosis of patients [1]. Diastolic function is the set of parameters that reflect the relaxation state of the ventricles and is regulated by the interaction of the right and left ventricles, left atrial (LA) function, pericardial influence on LV filling, LV systolic properties, coronary blood flow and tissue perfusion [2][3]. Echocardiographic assessment of LV diastolic function is essential for understanding cardiac function [4].

In the presence of LV diastolic dysfunction (LVDD) cardiovascular events are 3.53 times more frequent and the risk of death is 3.13 times higher [5]. The diagnosis of LVDD is essential as studies have shown that preclinical LVDD is the first manifestation of heart failure (HF) observable by echocardiography [6][7]. LVDD associated with HF with preserved ejection fraction (HFpEF) is a leading cause of HF in people older than 65 years, and the prevalence increases as the population ages and the epidemics of obesity, diabetes mellitus, and metabolic syndrome continue to spread [8][9]. Diastolic dysfunction is classified into three grades: grade 1, grade 2, and grade 3 according to the joint guideline of the American Society of Echocardiography and the European Society of Cardiovascular Imaging [10]. The prevalence of LVDD in older adults is variable according to different studies from 23–35%,71% for LVDD grade 1, 10% for grade 2 and 3% for grade 3 [11][12][13].

Factors known to be independently associated with LVDD include age (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.07–1.15), poor blood pressure control (OR 1.93; 95% CI 1.12–3.32), central obesity (OR 2.06; 95% CI 1.17–3.64), in people aged ≥ 50 years and a BMI ≥ 25 kg/m² are 13.82 times more likely to have LVDD [7][14]. The prevalence of LVDD is high in women and men with diabetes mellitus being 47% (95 % CI 3%-58%) and 46% (95 % CI 3%-55%) respectively, increased area visceral fat has been correlated with LVDD with a β: 0.242 p = < 0.001 [15].

The LVDD (grade 2–3 versus 1) is an independent predictor of hospitalization for heart failure in older adults with ischemic heart disease (HR: 1.69; 95% CI 1.04–2.75 p = 0.033) [16], however, the prevalence LVDD and associated factors in the elderly in Ecuador is unknown, so the main objective of this study was to determine the prevalence of LVDD and associated factors in older adults attending the Geriatrics outpatient clinic in the city of Cuenca.

It was a cross-sectional, analytical study was carried out at the “Hospital de Especialidades José Carrasco Arteaga” in Cuenca´s city.

Study population and assessment criteria

Elderly men and women who attended the geriatric consultation at the “Hospital de Especialidades José Carrasco Arteaga” in the city of Cuenca. The sample consisted of 172 patients, 14 patients were eliminated due to poor image quality and 158 cases were analyzed.

Inclusion criteria were men and women aged ≥ 65 years. Exclusion criteria were hypertensive crisis (blood pressure ≥ 180/110 mmHg after 2 minutes of the third blood pressure measurement), chronic kidney disease stage 5 on dialysis, sinus tachycardia (heart rate greater than 110 beats), pacemaker, resynchronizer or implantable automatic defibrillator wearer, severe obstructive pulmonary disease, heart surgery (scar in the anterior thorax), history of stroke, history of heart disease (congenital heart disease, cardiomyopathy), inability to climb on a scale or bioimpedometer, mental or physical alterations that prevent taking anthropometric measurements and/or answering the questions asked within the study.

Each patient signed the informed consent form, then data were obtained on age, sex, blood pressure, weight, height, body mass index (BMI), waist circumference, visceral fat level. Data on arterial hypertension, diabetes mellitus and history of ischemic heart disease were obtained by survey, with dichotomous yes or no variables.

Blood pressure

Blood pressure was taken with an Omron digital sphygmomanometer, with the patient seated, with a 5-minute rest, with the left arm (preferably) or the right arm resting on a table at heart level, blood pressure was taken three times with a 1-minute difference and the value of the second and third measurements was averaged.

Body Mass Index (BMI), waist circumference, and visceral fat level

For BMI, underweight < 22 kg/m², normal ≥ 22 and 26.9 kg/m², overweight ≥ 27 to 32 kg/m² and obese > 32 kg/m² were considered [17]. Waist circumference was measured with a standing tape measure at the midpoint between the top of the anterior iliac crest and the lower edge of the last palpable costal margin. Abdominal obesity was defined as abdominal perimeter values ≥ 102 cm in men and ≥ 88 cm in women [14][18]. Visceral fat level (VFL) was measured using a multifrequency bioimpedometer TANITA RD-545 PRO body composition monitor, the patient was fasting for two hours. According to the manufacturer’s information, a rating between 1 and 12 indicates a healthy level of visceral fat, whereas a rating between 13 and 59 indicates excess visceral fat [19][20].

Transthoracic echocardiography

The echocardiogram was performed and the following variables were obtained: tissue velocity of the septal and lateral mitral annulus, indexed volume of the left atrium, left ventricular ejection fraction, indexed mass of the left ventricle, longitudinal deformation of the left ventricle and atrium, tricuspid regurgitation velocity. A General Electric IQ 2021 echocardiograph and an M5C transducer were used. All images were interpreted by an expert echocardiographer. All images and videos were sent to Echo PAC version 204 GE where off-line processing was performed. Poor quality echocardiographic images were excluded. Left ventricular ejection fraction was calculated using the ventricular volumes in the apical 4 and 2-chamber view with Simpson's method performed manually or semi-automatically with auto left ventricular ejection fraction.

With pulsed Doppler at 1–2 mm to obtain E and A wave velocity, at a speed of 25 to 50 mm/s. With tissue Doppler with spectral analysis to quantify the e' velocity of the septal and lateral mitral annulus, sweep speed of 50 to 100 mm/s at end-expiration. Tricuspid valve velocity was calculated from the pressure gradient between the right ventricle and right atrium. The left ventricular mass was estimated using the Devereux formula and indexed with the body surface area calculated by DuBois' formula and the E/e′ radius was obtained from the data emitted by the echocardiograph [12].

The longitudinal deformation of the left atrium, reservoir function was performed in the four-chamber view with speckle tracking. The longitudinal deformation of the left ventricle was performed with the 4 chambers view, 2 chambers and 3 chambers with the speckle tracking technique, only the images with 40 frames/second were analyzed [12].

Left ventricular diastolic dysfunction.

Diastolic dysfunction was a left ventricular ejection fraction equal to or greater than 50%, myocardial disease, and three or four diastolic function criteria. Myocardial disease was defined as LV dilatation, left ventricular hypertrophy or LV longitudinal deformation − 16%. Indeterminate those patients with two criteria. Normal those with no criteria or one of the four criteria [12].

Severity of diastolic dysfunction

Grade 1: If radius E/A ≤ 0.8 and E ≤ 50 cm/s or (E/A ≤ 0.8 and E > 50 cm/s or E/A between 0.8 and 2 with one of the following criteria: radius E/e' > 14, septal E/e' > 15, lateral E/e' > 13, peak IT velocity > 2.8 m/s or VIAI > 34 ml/m2). Grade 2: E/A between 0.8 and 2 with at least 2 parameters: E/e' ratio > 14, maximum IT velocity > 2.8 m/s and VIAI > 34 ml/m2. Grade 3: If E/A > 2 [12].

This study was approved on April 4, 2023 by the Bioethics Committee of the University of Cuenca CEISH-UC with Code 2023-004EO-MST-ICS.

Statistical analysis

The Kolmogorov Smirnov test was used to determine the goodness of fit of two probability distributions to each other, with a p value < 0,05 it was verified that the distribution was not normal, for which nonparametric tests were applied, with p value > 0.05 the variable was considered normally distributed and parametric statistics were applied. The indicators for quantitative variables with a nonparametric distribution were: the median, with minimum and maximum values, and for those with a parametric distribution, the data are presented as the mean ± SD. Categorical variables were expressed as frequencies and percentages. The prevalence of LVDD was determined as the proportion of people with LVDD in the overall study sample and was further classified into LVDD grades 1, 2 and 3.

The association between quantitative variables with parametric distribution, was analyzed by applying ANOVA, and for categorical variables the prevalence ratio with confidence interval, chi-square with a p < 0,05 was considered statistical significance. All analyses were performed using the SPSS version 25 statistical package.

Table 1

**Characteristics of the study population**
Characteristics	Women n = 92 (58.2%)	Men n = 66 (41.8%)	Total n = 158 (100%)
Demographics
Age years**	72 (65–92)	73 (65–94)	72 (65–94)
65–74 (%)	63 (58.88)	44 (41.12)	107 (67.72)
75–84 (%)	21 (55.26)	17 (44.74)	38 (24.05)
≥ 85 (%)	8 (61.54)	5 (38.46)	13 (8.23)
Blood pressure
Systolic, mmHg*	131.91±3,34	137.26±4.11	134.18±2.57
Diastolic, mmHg *	75.55±2,15	77.89±2.15	76.53±1.53
Anthropometric
Weight, Kg*	63.95±1,95	72.30±2.54	67.44±1.60
Waist, cm*	94.33±1.98	98.80±2.11	96.19±1.48
Height, m**	1.49 (1.3–1.6)	1.62 (1.5–1.7)	1.53 (1.30–1.70)
VFL**	11.50 (6.50–22)	16.50 (11-27.50)	13.50 (6.50–27.50)
BMI**	27.90 (20.5–40.2)	27.24 (18.2–39.6)	27.65 (18.2–40.2)
Underweight (%)	3 (60)	2 (40)	5 (3.16)
Normal (%)	28 (50)	28 (50)	56 (35.44)
Overweight (%)	42 (59.15)	29 (40.85)	71 (44.94)
Obese (%)	19 (73.08)	7 (26.92)	26 (16.45)
Obesity waist (%)
Yes	70 (76.09)	22 (23.91)	92 (58.22)
No	22 (33.3)	44 (66.7)	66 (41.77)
Visceral fat (%)
High	34 (35.1)	63 (64.9)	97 (61.39)
Normal	58 (95.1)	3 (4.9)	61 (38.60)
Clinical
Hypertension (%)	55 (55.56)	44 (44.44)	99 (78.57)
Diabetes mellitus (%)	15 (75)	5 (25)	20 (15.87)
Ischemic cardiopathy (%)	0	7 (100)	7 (5.55)
Echocardiography
Tricuspid regurgitant velocity, m/s*	2.54±0.06	2.50±0.08	2.52±0.05
Left atrial reservoir strain, %*	24.32±1.29	24.30±1.68	24.31±1.02
Global longitudinal strain, %*	19.21±0.54	18.22±0.68	18.80±0.42
Left ventricular mass, gr/m² **	67.54 (36.48-122.77)	82.14 (38.34-112.84)	69.59 (36.48-122.77)
E**	0.69 (0.32–1.20)	0.60 (0.37–1.09)	0.64 (0.32–1.20)
E/A**	0.78 (0.39–2.45)	0.80 (0.49–1.74)	0.80 (0.39–2.45)
Septal e´, cm/s**	0.07 (0.03–0.10)	0.06 (0.04–0.11)	0.07 (0.03–0.11)
Lateral e´, cm/s**	0.08 (0.04–0.15)	0.08 (0.04–0.15)	0.08 (0.04–0.15)
Septal E/e´ **	10.18 (5.50–21.20)	8.95 (3.78–16.01)	9.57 (3.78–21.20)
Lateral E/e´ **	8.07 (3.74–15.10)	7.14 (3.84–17.84)	7.75 (3.74–17.84)
Mean E/e´ **	9.04 (0.87–17.34)	7.98 (4.67–16.31)	8.68 (0.87–17.34)
Left atrial volume index, ml/m²**	31.04 (12.97–63.72)	31.48 (20.86–90.72)	31.27 (12.97–90.72)
LVEF**	67 (53–82)	68 (51–80)	67.5 (51–82)
Diastolic function (%)
Normal	49 (55.68)	39 (44.32)	88 (55.69)
Indeterminate	23 (58.97)	16 (41.03)	39 (24.68)
Dysfunction	20 (64.52)	11 (35.48)	31 (19.62)
Severity LVDD (%)
Grade 1	8 (53.33)	7 (46.67)	15 (48.38)
Grade 2	10 (71.43)	4 (28.57)	14 (45.16)
Grade 3	2 (100)	0	2 (6.45)
**median (minimum - maximum)
*mean±standard deviation
BMI: Body Mass Index, VFL: visceral fat level, LVEF: Left Ventricule Ejection Fraction, LVDD: Left ventricule diastolic dysfunction

Table 1 shows the general characteristics of the population according to demographic, anthropometric, clinical and echocardiographic characteristics. The sample consisted of 158 participants, 92 women (58.2%). The median age was 72 years (65–94 years). The most representative age group was 65–74 years, comprising 107 individuals, in the range of 75–84 years 38 people were included and with age ≥ 85 years 13 cases were studied, represented mostly by women 63 (59%), 21 (55.26%) and 8 (61.54%) respectively.

Blood pressure was controlled, an average systolic pressure of 134 mmHg (95% CI 131.61-136.75) and diastolic pressure was observed at 76 mmHg (95% CI 75-78.06).

Regarding BMI, a median of 27.65 kg/m² (18.2–40.2) was found, which in this study was defined as overweight, although both women and men had similar BMI 27.90 versus 27.24, women had higher ranges of 20.5–40.2 men 18.2–39.6 kg/m².

The mean waist circumference was 96.19 cm (95% CI 94.72–97.67), of the total sample studied 92 people (58.22%) had abdominal obesity. Of the total sample studied, 92 people (58.22%) had abdominal obesity.

Among the 158 participants, 99 (78.57%) were hypertensive, 20 (15.87%) were diabetic and 7 (5.55%) were found to have ischemic heart disease.

Applying the 2016 ASE/EACVI diastolic function recommendations, we obtained a prevalence of normal diastolic function of 55.7%, indeterminate of 24.7% and LVDD of 19.6%. Of the 158 patients observed, 31 had LVDD, with a prevalence of grade 1 of 48.39%, for grade 2 of 45.16% and grade 3 of 6.45%.

Table 2

**Association between diastolic function and demographic, anthropometric and clinical characteristics**
Characteristics	Diastolic function		PR	95% IC
	LVDD (%) n = 31 (19.6)	WLVDD (%) n = 127 (80.37)
Sex (%)
Women	20 (21.7)	72 (78.3)	1.30	0.67–2.54	0.428
Men	11 (16.7)	55 (83.3)	Ref
Age (%)
≥ 75	16 (31.4)	35 (68.6)	2.24	1.20–416	0.010
65–74	15 (14)	92 (86)	Ref
BMI (%)
≥ 32	5 (19.2)	21 (80.8)	1.01	0.82–1.24	0.942
< 32	26 (19.8)	105 (80.2)	Ref
Obesity waist (%)
Yes	22 (23.7)	71 (76.3)	1.71	0.84–3.47	0.127
No	9 (13.8)	56 (86.2)	Ref
Visceral fat (%)
High	20 (20.6)	77 (79.4)	1.14	0.59–2.22	0.690
Normal	11 (18)	50 (82)	Ref
Hypertension (%)
Yes	22 (22,2)	77 (77.8)	1.46	0.72–2.95	0.286
No	9 (15.3)	50 (84.7)	Ref
T2DM (%)
Yes	5 (25.0)	15 (75.0)	1.33	0.58–3.06	0.517
No	26 (18.8)	112 (81.2)	Ref
Ischemic cardiopathy (%)
Yes	3 (42.9)	4 (57.1)	2.31	0.92–5.79	0.137
No	28 (18.5)	123 (81.5)	Ref

BMI: body mass index; LVDD: left ventricular diastolic dysfunction; WLVDD: without left ventricular diastolic dysfunction; PR: prevalence ratio; CI: 95% confidence interval; Ref: reference; X² = p-value; T2DM: type 2 diabetes mellitus.

Table 2 shows that, of the 158 patients, 31 (19.5%) were classified as LVDD and 127 (80.37%) as adult WLVDD. Of the 31 LVDD cases, 16 (31.4%) had an age ≥ 75 years and 15 (14%) an age less than 75 years, when analyzing the association between age and diastolic dysfunction a Prevalence Ratio (PR) was performed with a value of 2.24 (95% CI 1.20–4.16) p = 0.010, meaning that having age ≥ 75 years is 2.24 times more likely to find diastolic dysfunction in an echocardiogram.

Sex is a variable that behaves equally with respect to diastolic function, of the 31 LVDD patients, 11 (16.7%) were men and 20 (21.7%) women, when analyzing sex as a factor of association we obtained a PR: 1.30 (95% CI 0.67–2.54) p = 0.428.

The individuals with obesity and LVDD were 5 (19.2%); on the other hand, with BMI < 32 were 26 (19.8%). With a PR: 1.01 (95% CI 0.82–1.24) with a p value = 0.942.

Of the 31 LVDD individuals, 22 (23.7%) had obesity waist, PR: 1.7 (95% CI 0.84–3.47), p value = 0.127. Of those LVDD patients, 20 (20.6%) individuals were found and 11 (18%) WLVDD, PR: 1.14 (95% CI 0.59–2.22), p value = 0.690.

We found 22 (22.2%) LVDD cases in hypertensive patients, PR: 1.46 (95% CI 0.72–2.95) and p value = 0.286. In 5 (25%) LVDD cases in diabetics, PR: 1.33 (95% CI 0.58–3.06) and p value = 0.517, and 3 (43%) LVDD in ischemic heart disease, with a PR: 2.31 (95% CI 0.92–5.79) and p value = 0.137.

The prevalence of LV diastolic dysfunction in older men was 16.7% and 21.7% in women.

The prevalence of LV diastolic dysfunction in older adults with systemic arterial hypertension was 22.2%.

The prevalence of LV diastolic dysfunction in older adults with type 2 diabetes mellitus was 25%.

The prevalence of LV diastolic dysfunction in older adults with ischemic heart disease was 42.9%.

ANOVA = analysis of variance, BMI: Body Mass Index

Graph 1 shows the difference between the means of the longitudinal deformation of the left atrial reservoir function and the BMI categories, an ANOVA p value = 0.003 was obtained, the reservoir strain of the left atrium is altered or decreases its value with respect to higher BMI, the Tukey significance test showed a difference in means between underweight and normal with p value = 0.563, between normal BMI and overweight with p value = 0.034, between overweight and obesity with p value = 0.035.

The present study was performed in patients aged 72 years and a prevalence of normal diastolic function was obtained in 55.7%, indeterminate range in 24.7% and LVDD in 19.6%. In an argentine population in 2020, performed in people aged 60 years, were diagnosed with LVDD in 23% [11]. These studies are comparable to each other, except that in the argentine work the participants had lower age, lower rates of hypertension (63% vs 78%), higher rates of obesity (40% vs 16%), the proportion of diabetes mellitus in both studies was similar at 16%.

In a danish population, in the year 2022, conducted in people aged 74 years the prevalence of LVDD was 27% [12], higher proportion of hypertension and diabetes mellitus were reported than the current study (91 vs. 78 % ad 29 vs. 16% respectively).

In the current investigation the prevalence of grade 1 LVDD was 48.38%, grade 2 was 45.16% and grade 3 was 6.45%. In a danish population, in the year 2022, the prevalence of LVDD grade 1 was reported to be 71%, grade 2 10% and 3% grade 3 [12). Although the presence of grade 1 LVDD may not seem very alarming, evidence from prospective cohort studies in western populations indicated that they may deteriorate over time [13].

It is noteworthy that age ≥ 75 years was significantly associated with diastolic function, a PR: 2.24 (95% CI 1.20–4.16) p = 0.010, highlighting that people in this age group could be monitored in periodic medical controls, perform an echocardiogram and quantify diastolic function parameters. Other studies also showed that age is the main determinant of LVDD [12][21].

A study in 2022 reported that the prevalence of LVDD in hypertensives was 24.4% [6], it study showed a prevalence of LVDD in hypertensives people was 22.2%.

In a meta-analysis published in 2018 performed in a population with type 2 diabetes mellitus reported a prevalence of LVDD of 35% [13], in this study the prevalence of LVDD in diabetics people was 25%, it should be commented that the operational definition of diabetes mellitus in the present investigation was based on previous diagnosis or taking oral antidiabetic medication or insulin use.

Visceral fat had a PR: 1.14 (95% CI 0.59–2.22) p = 0.690, indicating that this variable is equal in patients with and without diastolic dysfunction different from what a group of researchers published in 2019, they used DEXA Advanced Body Composition Study for the measurement of fat in abdomen [15].

In year 2022 a group of investigators, studied patients aged ≥ 70 years with acute coronary syndrome, they followed them for 1 year, they found that LVDD grade 2 was a predictor of hospitalization HR: 2.01; 95% CI 1.04–2.75, p = 0.033 [16]. In the present study the prevalence of LVDD was 43% in older adults with ischemic heart disease, which could indicate that this group of patients are at risk of hospitalization.

In the present study, people with LVDD and obesity or BMI ≥ 32 kg/m² were found in 19.2%, and without obesity BMI < 32 kg/m² in 19.8%, with a PR:1.01 (95% CI 0.82–1.24) p = 0.942, showing that there was no association between obesity and LVDD in the elderly. An study conducted in people with type 2 diabetes mellitus, in the year 2022, showed that for every 1 kg/m² increase BMI, it was associated with DDVI, with an OR: 1.12 (95% CI 1.00-1.24) p = 0.041, and diabetes mellitus could be an aggravating factor, in the current study 16% of diabetic patients were included [7].

In this study, significant differences were found between mean LA reservoir strain and BMI, ANOVA p = < 0.003. These findings indicate that obesity and underweight impact on a reduction of LA reservoir function in the elderly, suggesting that LA strain obtained by speckle-tracking echocardiography is an indicator of adverse LA functional remodeling in obesity. A study conducted in 2019 in persons aged 35–55 years found significant differences in LA strain with BMI ANOVA p = < 0.01 [22].

In this study that abdominal obesity had a PR: 1.71 (95% CI 0.84–3.47) p = 0.127 different from that reported by Ching's group with an OR 2.06 (95% CI 1.17–3.64) where LVDD was diagnosed by observing the E/A radio reading, different to it investigation where LVDD was defined like recommendations for the evaluation of left ventricular diastolic function by echocardiography [6].

Among the strengths of this research is that it is the first study conducted in Ecuador on LVDD in older adults who attended the Geriatrics office of a tertiary hospital.

As for the weaknesses, it should be commented that it was an analytical cross-sectional study carried out in a population of a Geriatrics service of a tertiary hospital, with average arterial pressures within normal parameters, with follow-up by the geriatrician.

Our findings of high prevalence of LVDD grade 1, indicate the need for strategies to detect and monitor the progression of LVDD with transthoracic echocardiography.

This cross-sectional study showed a 20% prevalence of LVDD in a sample of older adults. The majority of patients 48.39% with LVDD were in grade 1/mild severity. Older age was associated with diastolic dysfunction. These findings emphasize the need to perform echocardiogram screening for LVDD and follow-up of the progression of cardiac dysfunction given the long-term prognostic implications of LVDD. Future studies should investigate the role of aggressive risk factor modification in older adults with obesity and LA dysfunction to reduce the risk of obesity-related cardiovascular comorbidities, specifically heart failure and atrial fibrillation.

All authors contributed to the conception and design of the study. Material preparation, data collection, and data analysis were performed by Karol Andrea Guzmán Guillén, and Sandra Victoria Abril Ulloa. The first draft of the manuscript was written by Karol Andrea Guzmán Guillén and two authors commented on earlier versions of the manuscript. The authors read and approved the final manuscript.

Conflict of interest

The authors declare that they have no conflict of interest

Acknowledgments

To the Nutritionist Dr. Tania Carrera, and to the Geriatricians Dr. Carmen Cedillo and Dr. Andrea Rodriguez.

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Graph 1 is available in the Supplementary Files section.

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Prevalence of left ventricular diastolic dysfunction and effect of obesity on left atrial strain in older adults of Geriatric department

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Abstract

Introduction

Methodology

Study population and assessment criteria

Blood pressure

Body Mass Index (BMI), waist circumference, and visceral fat level

Transthoracic echocardiography

Severity of diastolic dysfunction

Statistical analysis

Results

Discussion

Conclusion

Declarations

References

Graph 1

Additional Declarations

Supplementary Files

Status:

Version 1