Echocardiographic parameters differentiating heart failure with preserved ejection fraction from asymptomatic left ventricular diastolic dysfunction

Abstract

Background (LVDD) either remains latent or manifests as heart failure with preserved ejection fraction (HFpEF). Little is known about echocardiographic parameters associated with symptomatic phenotype. Objective To investigate echocardiographic parameters associated with symptomatic state in LVDD. Methods Three hundred and thirty patients with definite diagnosis of LVDD (according to ASE/EACVI recommendations 2016) were included and divided into asymptomatic LVDD and HFpEF groups according to presence of dyspnea and brain natriuretic peptide levels. We excluded patients with left ventricular ejection fraction <50%, significant valvular heart disease, chronic lung disease, or renal dysfunction. Results Mean age was 61.2 ± 8.3 years; 71% were females. Both groups were matched regarding age, gender, comorbidities, and drug history. HFpEF group showed significantly larger BMI (P = .04), significantly higher IVS thickness (P < .001), LA diameter (P < .001), LA volume index (P = .004), E velocity (P = .001), TR jet velocity (P = .03), and average E/e' ratio (P < .001).On the contrary, lateral e' velocity was significantly lower in HFpEF group (P < .001). By regression analysis, lateral e' velocity was the best independent predictor of symptomatic state. Area under ROC curve of lateral e' velocity was 0.789 (0.667‐0.911, P < .001) to predict symptomatic state in LVDD with the best cutoff value of ≤8.2 cm/s (76% sensitivity and 79% specificity). Moreover, lateral e' velocity was significantly negatively correlated with NYHA class in HFpEF group. Conclusion Reduced lateral e' velocity was associated with symptomatic state in LVDD. Moreover, it was significantly negatively correlated with NYHA class in HFpEF.

Echocardiographic diagnosis of left ventricular diastolic dysfunction: Impact of coronary artery disease

“…It has been recently shown that DD and low e' are independent predictors of subclinical coronary artery calcification 34. Also, it has been recently reported that low e' lateral can be associated with symptom status in those with LVDD defined by 2016 ASE criteria, with e' lateral negatively correlating with NYHA class in preserved LVEF 35. One or more abnormal echocardiographic markers was found in a majority of an asymptomatic group at low-to-intermediate risk for CAD; few in this group were identified echocardiographically as having DD 36.…”

Adipose tissue distribution is associated with cardio-metabolic alterations in adult patients with juvenile-onset dermatomyositis

“…LV diastolic cardiac function was assessed as early diastolic tissue velocity (e’). We defined systolic dysfunction as LAS ≤13.7% and diastolic dysfunction as e’ ≤8.2 cm/second, which are median—2SD of control values [ 27 ]. LV cardiac dysfunction was defined as occurrence of systolic and/or diastolic dysfunction.…”

Left Ventricular Diastolic Dysfunction Screening by a Smartphone-Case Based on Single Lead ECG

“…4 Echocardiography allows noninvasive diagnosis of early diastolic dysfunction. [5][6][7][8] However, echocardiography and in particular tissue doppler imaging remain expensive and are not considered to be a wide screening method for asymptomatic patients. As electrical and mechanical functions of cardiac performance are closely coupled, advanced signal processing and machine learning methods have been used to identify subtle alterations in a 12-lead electrocardiogram (ECG) in patients who were referred for coronary computed tomography.…”