All patientsN=226 Normal diastolic functionN=135 Grade I diastolic dysfunctionN=82 Grade ≥2 diastolic dysfunctionN=9   P value
Demographics          
Age, years 49.5±14.3 42.7±12.2 59.6±11.0 59±10 <0.0001
Female gender 177(78.3%) 104(77.0%) 67(82.6%) 6(66.7%) 0.50
Nationality         0.014
Lebanese 167(73.8%) 90(66.7%) 72(87.8%) 5(55.6%)  
Iraqi 51(22.6%) 40(29.6%) 8(9.8%) 3(33.3%)  
Others 8(3.5%) 5(3.7%) 2(2.4%) 1(11.1%)  
Body mass index, kg/m2 (n=222) 27.3±5.2 26.9±5.3 28.1±4.9 25.6±4.6 0.16
Body surface area, m2 (n=222) 1.8±0.2 1.8±0.2 1.8±0.1 1.7±0.2 0.11
Comorbidities          
Systolic blood pressure, mmHg (n=208) 127±17 123±15 133±17 136±22 <0.0001
Hypertension 57(25.2%) 22(16.3%) 29(35.3%) 6(66.7%) <0.0001
Diabetes 20(8.8%) 7 (5.2%) 11 (13.4%) 2 (22.2%) 0.042
Prior revascularization 17(7.6%) 5 (3.7%) 11 (13.4%) 1 (11.1%) 0.030
Smoking history 81(35.8%) 44(32.6%) 34(41.5%) 3(33.3%) 0.43
Sedentary lifestyle 190(84.0%) 109(80.7%) 74(90.2%) 7 (77.8%) 0.12
Cancer type         0.17
Breast cancer 147(65.0%) 87(64.4%) 55(67.1%) 5(55.6%)  
Lymphoma 27 (11.9%) 19 (14.1%) 7(8.5%) 1(11.1%)  
Other 52(23.0%) 29(21.5%) 20(24.4%) 3(33.3%)  
Creatinine, mg/dl (n=202) 0.74±0.4 0.70±0.2 0.75±0.2 1.24±1.4 <0.0001
Glomerular filtration rate, ml/min/1.72m2 (n=194) 130±47 144±46 115±39 73±45 <0.0001
Medications          
Beta blockers 48(21.2%) 15(11.1%) 29(35.4%) 4(44.4%) <0.0001
ACEi/ARB 40 (17.7%) 15(11.1%) 21(25.6%) 4(44.4%) 0.003
Statins 35(15.5%) 12 (8.9%) 21 (25.6%) 2 (22.2%) 0.004
Anthracyclines or monoclonal antibodies based tyrosine kinase inhibitors 49(21.7%) 33(24.4%) 15(18.3%) 1(11.1%) 0.42
Echocardiographic parameters          
LVEDd/height, mm/m (n=221) 28±3 28±4 27±3 29±4 0.22
LVESd/height, mm/m (n=220) 18±2 19±2 18±2 19±3 0.47
LV mass index, g/m2 (n=212) 46±12 43±9 49±12 61±24 <0.0001
Ejection fraction, % 59.8±3.9 59.6±3.8 60.2±4.2 59.8±2.6 0.54
Global longitudinal strain, % (n=87) -19.8±2.3 -20±2.3 -19.4±2.3 -19.2±1.9 0.54
LA volume index, ml/m2 (n=216) 23±5 22±5 24±6 34±3 <0.0001
E, cm/s 74±18 81±17 63±13 83±18 <0.0001
A, cm/s 72±19 65±16 83±17 68±18 <0.0001
E/A 1.14±0.70 1.38±0.82 0.76±0.10 1.25±0.26 <0.0001
Deceleration time, ms 205±35 185±23 238±27 184±24 <0.0001
e’ lateral, cm/s 11.4±3.4 13.2±3.0 8.3±1.5 8.4±1.1 <0.0001
E/e’ 7.04±2.29 6.4±1.9 7.8±2.2 10±3.9 <0.0001
TAPSE, mm (n=172) 23±12 22±4 24±19 23±4 0.70
Right ventricular S’, cm/s (n=198) 14±3 14±3 14±4 14±3 0.76
Systolic PAP, mmHg (n=111) 28±6 28±6 28±5 32±6 0.10
Table 1: Baseline characteristics of all patients stratified by initial diastolic function. P value comparing all 3 groups. ACEi: Angiotensin Converting Enzyme Inhibitors; ARB: Angiotensin Receptor Blocker; LA: Left Atrial; LV: Left Ventricular; LVEDD: Left Ventricular End- Diastolic Diameter; LVESD: Left Ventricular End-Systolic Diameter; PAP: Pulmonary Artery Pressure; TAPSE: Tricuspid Annular Plane Systolic Excursion