Evaluation of the relationship between endothelial glycocalyx shedding and asymptomatic left ventricular diastolic dysfunction — a study based on a Chinese elderly physical examination cohort

Coronary microvascular dysfunction (CMD) has been confirmed to be associated with cardiac diastolic dysfunction (DD). Moreover, endothelial glycocalyx (EG) is essential for microvascular homeostasis, and its shedding is related to CMD. However, no studies have focused on whether EG shedding is related to the presence and development of DD. We conducted this study in a cohort of Chinese elderly people. Consecutive patients without symptoms of heart failure (HF) were enrolled in this cohort. Serum syndecan-1 was measured by enzyme-linked immunosorbent assay, and DD was evaluated by echocardiography. A total of 503 patients were enrolled and divided into two groups by the median syndecan-1: the high syndecan-1 group (HSG) and the low syndecan-1 group (LSG). There was a difference in the prevalence of DD between the HSG and LSG [40 (15.81%) vs. 9 (3.57%), P<0.01]. In multivariable analysis, syndecan-1 was independently related to DD (odds ratio (per 10 units): 1.12, P<0.01)). In diagnostic tests, syndecan-1 was able to predict DD. Moreover, the combination of syndecan-1 and HOMAGE score, which comprehensively reflects the traditional risk factors for DD, improved the predictive ability of HOMAGE score alone (NRI:0.75, P=0.02; IDI:0.16, P=0.03). During a median follow-up of 23 months, we found that the annual changes in echocardiographic diastolic parameters (E/e’, Septal e’, Lateral e’) of HSG deteriorated worse than those of LSG (P trend < 0.01 for all). EG shedding, assessed by serum syndecan-1, is independently associated with the presence and development of DD among elderly patients without overt HF.