Diastolic Dysfunction in Adults with Preserved Ejection Fraction: Prevalence and Predictors in Kenyan Tertiary Referral Hospital

Background Diastolic dysfunction (DD), a precursor to heart failure with preserved ejection fraction (HFpEF), is associated with significant morbidity and mortality. Data on DD in Sub-Saharan Africa (SSA) remain limited. This study aimed to determine the prevalence and describe the clinical and echocardiographic characteristics of DD in a cohort of adult patients at a tertiary referral facility in Kenya. Methods In this prospective cohort study, we reviewed 1,205 echocardiographic examinations performed in a six-month period in 2020 at the Aga Khan University Hospital, Nairobi, Kenya. Diastolic function was assessed based on the 2016 ASE/EACVI guidelines. Patients with preserved left ventricular (LV) systolic function (Left Ventricular Ejection Fraction [LVEF] ≥ 50%) and evidence of diastolic abnormalities were evaluated, and those meeting guideline criteria for DD were included in the final analysis. Results Among the 1,205 echocardiograms reviewed, 43.1% (n = 519) showed at least one diastolic abnormality, and 32.1% (n = 387) met the inclusion criteria. Of these, 53.2% (n = 206) were classified as having severe DD, while 46.8% (n = 181) had borderline DD. The mean age of participants was 62.8 ± 12.3 years. The most common symptoms were dyspnea (54.8%), chest pain (31.5%), and fatigue (27.1%). Hypertension was affecting 78.6%. Multivariate analysis identified the following independent predictors of severe DD: chronic kidney disease (OR: 8.07, 95% CI: 3.25–19.99), preexisting heart failure (OR: 6.04, 95% CI: 3.26–11.17), atrial fibrillation (OR: 5.43, 95% CI: 1.57–18.83), pacemaker implant (OR: 4.95, 95% CI: 1.09–22.5), dyspnea (OR: 3.39, 95% CI: 1.76–6.55), anemia (Hb < 10 g/dL) (OR: 2.04, 95% CI: 1.24–3.36), hypertension (OR: 2.04, 95% CI: 1.22–3.43), advanced age (OR: 1.02, 95% CI: 1.01–1.04), and elevated NT-proBNP (OR: 18.52, 95% CI: 3.36–101.9). Echocardiographic parameters associated with severe DD included LV hypertrophy (OR: 2.67, 95% CI: 1.61–4.4), abnormal global longitudinal strain (OR: 1.66, 95% CI: 1.009–2.74), and low-normal LV systolic function (OR: 1.64, 95% CI: 1.06–2.53). Conclusion This study shows that a third of patients referred for echocardiography at a tertiary referral hospital in Kenya have diastolic dysfunction, the majority severe. Traditional cardiovascular risk factors: hypertension and chronic kidney disease, were strongly associated with severe DD. These findings underscore the importance of early detection and aggressive management of cardiovascular risk factors to prevent the onset and progression of HF in Sub-Saharan Africa.