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Bitar ZI, Maadarani O, Dashti H, Alenezi A, Almerri K. A prospective analysis of the correlation between ultrasonic B-lines, cardiac tissue doppler signals and left ventricular end-diastolic pressure in patients with severe aortic stenosis. Echo Res Pract 2024; 11:21. [PMID: 39129021 PMCID: PMC11318176 DOI: 10.1186/s44156-024-00055-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/02/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND The development of heart failure is a turning point in the natural course of aortic stenosis (AS). Pulmonary oedema and elevated left ventricular pressure (LVP) are cardinal features of heart failure. Evaluating pulmonary oedema by lung ultrasound involves taking the upper hand with a bedside noninvasive tool that may reflect LVP. AIM We sought to assess the correlation between sonographic pulmonary congestion, invasive LV pre-A pressure, and echocardiographic LV end-diastolic pressure (LVEDP) in symptomatic AS patients receiving transcatheter aortic valve replacement. METHODS Forty-eight consecutive patients with severe AS and planned transcatheter aortic valve implantation (TAVI) were enrolled. LVEDP was estimated to be normal or elevated using the ASE/EACVI algorithm and transmitral Doppler indices, the E/A ratio, the E/e', and the left atrial volume index. Invasive LV pre-A pressure was used as a reference, with > 12 mm Hg defined as elevated. RESULTS Forty-eight patients (25 women (52%), mean age 75 years, standard deviation (SD) ± 7.7 years) were enrolled in the study. We detected severe B-lines (≥ 30) in 13 (27%) patients and moderate B-lines (15-30) in 33 (68.6%) patients. The number of B-lines increased significantly with the severity of New York Heart Association (NYHA) functional classes (Fig. 1). The B-line count was 14 ± 13 in NYHA class I patients, 20 ± 20 in class II patients, and 44 ± 35 in class III patients (p < 0.05, rho = 0.384). The number of B-lines was correlated with the E/E' ratio (R = 0.664, p < 0.0001) and the proBNP level (R = 0. 882, p < 0.008). We found no significant correlation with the LVEDP or LVEF. The LVEDP correlated well with the E/E' ratio (R = 0.491, p < 0.001) but not at all with E/A, DT, or LAVI. All patients had an elevated LVEDP > 12, with a mean pressure of 26 mmHg, a minimum of 13 mmHg, and a maximum of 45 mmHg, with an SD of 7.85. CONCLUSION Assessing lung ultrasonic B-lines is a straightforward and practical approach to identifying pulmonary oedema in AS patients. The number of B-lines correlated with the E/E' ratio and the functional status of patients but did not correlate with invasive LVEDP or LVEF. All patients had elevated LVEDP that correlated with E/E'.
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Affiliation(s)
- Zouheir Ibrahim Bitar
- Consultant critical care medicine Internal medicine department Ahmadi hospital, Ahmadi, Kuwait.
- Critical care Unit, Ahmadi hospital, Fahahil, 64015, Kuwait.
| | - Ossama Maadarani
- Critical care Unit, Ahmadi hospital Kuwait oil company, Ahmadi, Kuwait
| | - Hussien Dashti
- Consultant internal medicine Internal medicine department, Ahmadi hospital, Ahmadi, Kuwait
| | - Abdullah Alenezi
- Consultant interventional cardiology Cardiology depart, Chest Hospital, Shuwaikh, Kuwait
| | - Khaled Almerri
- Department of Cardiology, Chest Disease Hospital, Shuwaikh, Kuwait
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Inoue N, Ohtani H, Morikawa S, Takayama Y, Ogane T, Hiramatsu T, Kumihashi H, Murohara T. Risk of supranormal left ventricular ejection fraction in patients with aortic stenosis. Clin Cardiol 2024; 47:e24255. [PMID: 38469926 PMCID: PMC10928761 DOI: 10.1002/clc.24255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Cardiovascular events are increasing in patients with supranormal left ventricular ejection fraction (snLVEF). However, the effect of snLVEF in patients with aortic stenosis (AS) remains unclear, especially in patients with moderate AS. HYPOTHESIS This study aimed to evaluate the prognosis of mortality and heart failure (HF) in patients with LVEF ≥ 50% and moderate or severe AS. METHODS This retrospective study targeted patients with moderate or severe AS and LVEF > 50%. LVEF of 50%-65% was classified as normal LVEF (nLVEF, nEF group) and >65% as snLVEF (snEF group). AS severity was stratified based on the aortic valve area into moderate (1.0-1.5 cm²) and severe (<1.0 cm²). Primary outcomes included all-cause mortality and HF hospitalization. RESULTS A total of 226 participants were included in this study. There were 67 and 65 participants with moderate AS in snEF (m-snEF) and nEF groups (m-nEF), respectively, and 41 and 53 participants with severe AS in the snEF (s-snEF) and nEF groups (s-nEF), respectively. During the observation period (median: 554 days), the primary composite outcome occurred in 108 individuals. Cox hazard analysis revealed no significant differences among the four groups in primary composite outcomes. With respect to HF hospitalization, the adjusted hazard ratios (95% confidence intervals) with m-snEF as the reference were as follows: m-nEF, 0.41 (0.19-0.89); s-nEF, 1.43 (0.76-2.67); and s-snEF, 1.83 (1.00-3.35). CONCLUSIONS The risk of HF hospitalization for m-snLVEF was higher than m-nLVEF and not significantly different from s-nLVEF.
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Affiliation(s)
- Naoya Inoue
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineShizuokaHamamatsuJapan
| | - Shuji Morikawa
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Yohei Takayama
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Takashi Ogane
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
| | - Takehiro Hiramatsu
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Hiroki Kumihashi
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
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Nishida G, Calvilho Junior AA, Assef JE, Dos Santos NSS, de Andrade Vilela A, Braga SLN. Left atrial strain as a predictor of left ventricular filling pressures in coronary artery disease with preserved ejection fraction: a comprehensive study with left ventricular end-diastolic and pre-atrial contraction pressures. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2193-2204. [PMID: 37665484 DOI: 10.1007/s10554-023-02938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Assessing left ventricular (LV) filling pressure (LVFP) is challenging in patients with coronary artery disease (CAD) and preserved LV ejection fraction (LVEF). We aimed to correlate left atrial strain (LAS) with two invasive complementary parameters of LVFP and compared its accuracy to other echocardiographic data to predict high LVFP. This cross-sectional, single-center study enrolled 81 outpatients with LVEF > 50% and significant CAD from a database. Near-simultaneous echocardiography and invasive measurements of both LV end-diastolic pressure (LVEDP) and LV pre-atrial contraction (pre-A) pressure were performed in each patient, based on the definition of LVEDP > 16 mmHg and LV pre-A > 12 mmHg as high LVFP. A moderate to strong correlation was observed between LAS reservoir (LASr), contractile strain, and LVEDP (r: 0.67 and 0.62, respectively; p < 0.001); the same was true for LV pre-A (r: 0.65 and 0.63, respectively; p < 0.001). LASr displayed good diagnostic performance to identify elevated LVFP, which was higher when compared to traditional parameters. Median value of LASr was higher for an isolated increase of LVEDP than for simultaneously high LV pre-A. The cutoff found to predict high LVFP was lower for LV pre-A than that one for LVEDP. In the current study, LASr did not provide an additional contribution to the 2016 diastolic function algorithm. LAS is a valuable tool for predicting LVFP in patients with CAD and preserved LVEF. The choice of LVEDP or LV pre-A as the representative marker of LVFP leads to different cutoffs to predict high pressures. The best strategy for adding this tool to a multiparametric algorithm requires further investigation.
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Affiliation(s)
- Gustavo Nishida
- Dante Pazzanese Institute of Cardiology, Avenida Dante Pazzanese, 500. Vila Mariana, São Paulo, SP, 04012-909, Brazil.
| | | | - Jorge Eduardo Assef
- Dante Pazzanese Institute of Cardiology, Avenida Dante Pazzanese, 500. Vila Mariana, São Paulo, SP, 04012-909, Brazil
| | | | - Andrea de Andrade Vilela
- Dante Pazzanese Institute of Cardiology, Avenida Dante Pazzanese, 500. Vila Mariana, São Paulo, SP, 04012-909, Brazil
| | - Sergio Luiz Navarro Braga
- Dante Pazzanese Institute of Cardiology, Avenida Dante Pazzanese, 500. Vila Mariana, São Paulo, SP, 04012-909, Brazil
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Oh JK, Miranda WR, Kane GC. Diagnosis of Heart Failure With Preserved Ejection Fraction Relies on Detection of Increased Diastolic Filling Pressure, But How? J Am Heart Assoc 2023; 12:e028867. [PMID: 36892047 PMCID: PMC10111525 DOI: 10.1161/jaha.122.028867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Jae K Oh
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | - Garvan C Kane
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major public health problem that affects half of all patients with HF. It is rising in prevalence, is associated with high morbidity and mortality, and has very few effective treatments. HFpEF is currently understood as a heterogeneous syndrome originating from the interplay of cardiac and extracardiac abnormalities. The most important pathophysiology in patients with HFpEF is diastolic dysfunction, which presents with impairments in relaxation or increases in chamber stiffness that lead to an increase in left ventricular filling pressures at rest or during exercise that causes dyspnea.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Yuran Ahn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
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Lewis GA, Pearce K, Williams SG, Schelbert EB, Macnab A, Miller CA. The utility of cardiovascular imaging in heart failure with preserved ejection fraction: diagnosis, biological classification and risk stratification. Heart Fail Rev 2021; 26:661-678. [PMID: 33155067 PMCID: PMC8024231 DOI: 10.1007/s10741-020-10047-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 01/09/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) does not exist as a singular clinical or pathological entity but as a syndrome encompassing a wide range of clinical and biological phenotypes. There is an urgent need to progress from the unsuccessful 'one-size-fits-all' approach to more precise disease classification, in order to develop targeted therapies, personalise risk stratification and guide future research. In this regard, this review discusses the current and emerging roles of cardiovascular imaging for the diagnosis of HFpEF, for distilling HFpEF into distinct disease entities according to underlying pathobiology and for risk stratification.
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Affiliation(s)
- Gavin A Lewis
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK
| | - Keith Pearce
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK
| | - Simon G Williams
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK
| | - Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anita Macnab
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- Manchester University NHS Foundation Trust, Southmoor Road, WythenshaweManchester, M23 9LT, UK.
- Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Wellcome Centre for Cell-Matrix Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
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Peverill RE. Understanding preload and preload reserve within the conceptual framework of a limited range of possible left ventricular end-diastolic volumes. ADVANCES IN PHYSIOLOGY EDUCATION 2020; 44:414-422. [PMID: 32697153 DOI: 10.1152/advan.00043.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Preload has been variously defined, but if there is to be a direct relationship with activity of the Frank-Starling mechanism in its action to increase the force and extent of contraction, preload must directly reflect myocardial stretch. The Frank-Starling mechanism is activated during any stretch of a cardiac chamber beyond its resting size, which is present immediately before contraction. Every left ventricle has an intrinsic and limited range of possible volumes at end diastole. There is a curvilinear relationship between left ventricular (LV) end-diastolic pressure (LVEDP) and LV end-diastolic volume (LVEDV), and, at maximal or near maximal LVEDV, there will be a high LVEDP. Within the possible range, the LVEDV will be determined by the extent of filling, any change in LVEDV will result in changed activity of the Frank-Starling mechanism, and change in LVEDV might, therefore, be considered to represent change in preload. On the other hand, it is the difference between the current and the maximal possible LVEDV (or the preload reserve) that may be of the most clinical relevance. There is a reciprocal relationship between preload and preload reserve, with minor or absent LV preload reserve indicating that there will be either minimal or no increase in stroke volume following intravenous fluid administration. As left atrial pressure can remain within the normal range when the LVEDP is elevated, it is LVEDP, and not left atrial pressure, that provides the most reliable guide to preload reserve in an individual at a specific period in time.
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Affiliation(s)
- Roger E Peverill
- Monash Cardiovascular Research Centre, MonashHeart, Monash Health, Clayton, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Medical Centre, Monash University, Clayton, Victoria, Australia
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SARİCAM E, OCAL A. Guided therapy in patients with acute heart failure: left ventricular diastolic filling pattern and NT-proBNP. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.729105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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9
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Correlation of left atrial strain with left ventricular end-diastolic pressure in patients with normal left ventricular ejection fraction. Int J Cardiovasc Imaging 2020; 36:1659-1666. [PMID: 32363448 PMCID: PMC7438285 DOI: 10.1007/s10554-020-01869-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/24/2020] [Indexed: 02/07/2023]
Abstract
Left ventricular diastolic dysfunction (LVDD) remains challenging to be assessed by echocardiography. We sought to explore the relationship between left atrial strain and left ventricular (LV) diastolic function in patients with normal left ventricular ejection fraction (LVEF) by invasive left-heart catheterization. 55 consecutive individuals with LVEF > 50% underwent LV catheterization. Standard transthoracic echocardiography was performed during 12 h before or after the procedure. Left atrial (LA) strain were obtained by speckle tracking echocardiography. When LVEF ≥ 50%, the group with elevated left ventricular end-diastolic pressure (LVEDP) (n = 35) showed decreased left atrial reservoir strain (LASr) (35.2 ± 7.7% vs 21.3 ± 7.2%, p < 0.001), left atrial conduit strain (LASct) (17.6 ± 6.3% vs 11.9 ± 4.1%, p < 0.001), left atrial contraction strain (LAScd) (16.6 ± 7.2% vs 9.5 ± 5.0%, p < 0.001) and increased E/e′ ration(8.9 ± 2.6 vs 10.1 ± 3.5, p = 0.17). LVEDP negatively correlated with LASr (R = 0.662, p < 0.001), LASct (R = 0.575, p < 0.001) and LAScd (R = 0.456, p < 0.001), but not with E/e′. LASr, LASct and LAScd were all independent predictors of elevated LVEDP (p < 0.05), with a higher C-statistic for the model including LASr (0.95, 0.86 and 0.93 respectively). The area under the curve (AUC) for LASr is 0.914 (cutoff value is 26.7%, sensitivity is 90%, specificity is 82.9%). In patients with normal LV ejection fraction, left atrial strain presented good correlation with LVEDP, and LASr was superior to LASct and LAScd to predict LVEDP. LA strain demonstrated better agreement with the invasive reference than E/e′.
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Michaud M, Maurin V, Simon M, Chauvel C, Bogino E, Abergel E. Patients with high left ventricular filling pressure may be missed applying 2016 echo guidelines: a pilot study. Int J Cardiovasc Imaging 2019; 35:2157-2166. [DOI: 10.1007/s10554-019-01667-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
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11
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Diagnostic accuracy of lung ultrasound for identification of elevated left ventricular filling pressure. Int J Cardiol 2019; 281:62-68. [DOI: 10.1016/j.ijcard.2019.01.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/22/2022]
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Abergel E, Lafitte S, Mansencal N. Evaluation of left ventricular filling pressure: Updated recommendations lack new evidence and have severe interpretation issues. Arch Cardiovasc Dis 2018; 111:707-711. [DOI: 10.1016/j.acvd.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 10/27/2022]
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13
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Xu B, Klein AL. Utility of Echocardiography in Heart Failure With Preserved Ejection Fraction. J Card Fail 2018; 24:397-403. [PMID: 29802895 DOI: 10.1016/j.cardfail.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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14
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Miranda WR, Egbe AC, Hagler DJ, Taggart NW, Nishimura RA, Connolly HM, Warnes CA. Filling pressures in Fontan revisited: Comparison between pulmonary artery wedge, ventricular end-diastolic, and left atrial pressures in adults. Int J Cardiol 2018; 255:32-36. [DOI: 10.1016/j.ijcard.2017.12.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
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15
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Nerlekar N, Peverill RE. Confusion regarding the meaning of the term left ventricular filling pressure given the nonequivalence of left ventricular end-diastolic pressure and mean left atrial pressure. Am Heart J 2018; 196:e1-e2. [PMID: 29421021 DOI: 10.1016/j.ahj.2017.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Sato K, Grant ADM, Negishi K, Cremer PC, Negishi T, Kumar A, Collier P, Kapadia SR, Grimm RA, Desai MY, Griffin BP, Popović ZB. Reliability of updated left ventricular diastolic function recommendations in predicting elevated left ventricular filling pressure and prognosis. Am Heart J 2017. [PMID: 28625379 DOI: 10.1016/j.ahj.2017.03.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An updated 2016 echocardiographic algorithm for diagnosing left ventricular (LV) diastolic dysfunction (DD) was recently proposed. We aimed to assess the reliability of the 2016 echocardiographic LVDD grading algorithm in predicting elevated LV filling pressure and clinical outcomes compared to the 2009 version. METHODS We retrospectively identified 460 consecutive patients without atrial fibrillation or significant mitral valve disease who underwent transthoracic echocardiography within 24 hours of elective heart catheterization. LV end-diastolic pressure (LVEDP) and the time constant of isovolumic pressure decay (Tau) were determined. The association between DD grading by 2009 LVDD Recommendations and 2016 Recommendations with hemodynamic parameters and all-cause mortality were compared. RESULTS The 2009 LVDD Recommendations classified 55 patients (12%) as having normal, 132 (29%) as grade 1, 156 (34%) as grade 2, and 117 (25%) as grade 3 DD. Based on 2016 Recommendations, 177 patients (38%) were normal, 50 (11%) were indeterminate, 124 (27%) patients were grade 1, 75 (16%) were grade 2, 26 (6%) were grade 3 DD, and 8 (2%) were cannot determine. The 2016 Recommendations had superior discriminatory accuracy in predicting LVEDP (P<.001) but were not superior in predicting Tau. During median follow-up of 416 days (interquartile range: 5 to 2004 days), 54 patients (12%) died. Significant DD by 2016 Recommendations was associated with higher risk of mortality (P=.039, subdistribution HR1.85 [95% CI, 1.03-3.33]) in multivariable competing risk regression. CONCLUSIONS The grading algorithm proposed by the 2016 LV diastolic dysfunction Recommendations detects elevated LVEDP and poor prognosis better than the 2009 Recommendations.
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Affiliation(s)
- Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Andrew D M Grant
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kazuaki Negishi
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Paul C Cremer
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Tomoko Negishi
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Arnav Kumar
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Patrick Collier
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Richard A Grimm
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Brian P Griffin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Zoran B Popović
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
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