A Three-Year Observational Study of the Prevalence of Left Ventricular Diastolic Dysfunction in Asymptomatic Individuals With Cardiovascular Risk Factors

TL;DR

This study found that left ventricular diastolic dysfunction is rare in healthy asymptomatic people but common in those with hypertension, diabetes, or severe obesity.

Contribution

The study provides new prevalence data on subclinical LVDD in asymptomatic individuals with cardiovascular risk factors.

Findings

Clinically significant LVDD was found in 3.7% of healthy controls, 13.1% with hypertension, 10.9% with diabetes, and 29.1% with both.

Severe obesity showed the highest prevalence at 53.5%.

LVDD prevalence increased with the number of cardiometabolic risk factors.

Abstract

Background: Left ventricular diastolic dysfunction (LVDD) precedes heart failure and may remain undetected in asymptomatic individuals. Early identification is particularly relevant in populations with cardiometabolic risk factors, where subclinical LVDD could refine risk stratification and guide preventive strategies.

Objective: To determine the prevalence of clinically significant LVDD (grade II-III) among asymptomatic adults aged 51-70 years and to compare its burden across major cardiovascular risk groups.

Methods: This retrospective cross‑sectional study analyzed 10,434 transthoracic echocardiograms performed over three years (between 1st October 2022 and 30th September 2025) at a tertiary cardiac center. A total of 5,482 asymptomatic individuals aged 51-70 years were included after exclusion of symptomatic patients and patients with structural heart disease, ejection fraction <50%, arrhythmias, and grade I LVDD. Participants were categorized into healthy controls, isolated hypertension, isolated diabetes mellitus, combined hypertension and diabetes mellitus, and severe obesity (BMI >40 kg/m²). Diastolic function was assessed using guideline‑based Doppler echocardiographic criteria, and only grade II-III LVDD was classified as clinically significant.

Results: Clinically significant LVDD was present in 102 healthy controls (3.7%, 95% CI: 3.0-4.5). Prevalence was higher in hypertension (13.1%, 95% CI: 11.4-15.0), diabetes mellitus (10.9%, 95% CI: 9.0-13.1), and combined hypertension plus diabetes (29.1%, 95% CI: 24.4-33.8). The highest prevalence occurred in severe obesity (53.5%, 95% CI: 34.1-72.2). LVDD prevalence increased stepwise across escalating cardiometabolic risk profiles.

Conclusion: Clinically significant LVDD is uncommon in asymptomatic individuals without risk factors but substantially more prevalent in those with hypertension, diabetes, or severe obesity. The graded increase across risk categories underscores the cardiometabolic contribution to diastolic dysfunction. While routine screening of all asymptomatic individuals is not supported, targeted evaluation of high‑risk groups warrants further prospective investigation.

Figures