Left Ventricular Diastolic Dysfunction towards a HELPFul role for biomarkers

Abstract

In this thesis the trend over the last two decades of improved survival after a first hospitalisation for heart failure is shown in the Netherlands for both men and women. Furthermore it is shown that there is a relation between diabetes and stiffening of the heart, as well as heart failure, in both men and women. To evaluate the diagnostic and prognostic value of biomarkers in men and women with stiffening of the heart the HELPFul study was started. The rationale and design of this study is further explained in the this thesis. In this thesis the value of diagnostic models for heart stiffening and heart failure with preserved ejection fraction is tested and found to be reasonably effective. The role of worsening of the kidney function is examined, but after correction for potential confounders there was no longer a significant relationship with left ventricular diastolic dysfunction. In the different projects in this thesis large heterogeneity in between studies and in the definition of sitffening of the heart (left ventricular diastolic dysfunction) is found. These problems require further attention in the future if the these fields are to develop further. A individual patient data meta-analysis might be a solution to develop a new definition for left ventricular diastolic dysfunction.