Grading diastolic left ventricular function

Hummel, Yoran M.; Voors, Adriaan A.

doi:10.1093/eurjhf/hfr061

Cited by 5 publications

(4 citation statements)

References 9 publications

(12 reference statements)

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“…In conclusion, a combination of lateral E/e’ ratio, indexed left atrial volume and the difference between duration of reverse pulmonary vein atrial systolic flow and duration of mitral valve atrial wave flow showed a considerable added diagnostic value with sensitivity and specificity values, which were similar to those in the strategy proposed by Paulus et al [2], yet much higher than the one described by Nagueh et al [1]. However, similar to other parameters, pulmonary vein flow measurements are known to be achievable only in a modest portion of all patients, thus depicting the limited applicability of certain Doppler-echocardiographic measurements [51]. While the latter confirms our experience, it has to be emphasized that the ECG parameters assessed in our analysis could be obtained in every individual.…”

Section: Discussionsupporting

confidence: 69%

A Novel Electrocardiographic Index for the Diagnosis of Diastolic Dysfunction

et al. 2013

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BackgroundAlthough the assessment of diastolic dysfunction (DD) is an integral part of routine cardiologic examinations, little is known about associated electrocardiographic (ECG) changes. Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD.Methods and ResultsECG parameters correlating with echocardiographic findings of DD were retrospectively assessed in a derivation group of 172 individuals (83 controls with normal diastolic function, 89 patients with DD) and their diagnostic performance was tested in a validation group of 50 controls and 50 patients. The patient group with a DD Grade 1 and 2 showed longer QTc (422±24ms and 434±32ms vs. 409±25ms, p<0.0005) and shorter Tend–P and Tend–Q intervals, reflecting the electrical and mechanical diastole (240±78ms and 276±108ms vs. 373±110ms, p<0.0001; 409±85ms and 447±115ms vs. 526±119ms, p<0.0001). The PQ–interval was significantly longer in the patient group (169±28ms and 171±38ms vs. 153±22ms, p<0.005). After adjusting for possible confounders, a novel index (Tend–P/[PQxAge]) showed a high performance for the recognition of DD, stayed robust in the validation group (sensitivity 82%, specificity 93%, positive predictive value 93%, negative predictive value 82%, accuracy 88%) and proved a substantial added value when combined with the indexed left atrial volume (LAESVI, sensitivity 90%, specificity 92%, positive predictive value 95%, negative predictive value 86%, accuracy 91%).ConclusionsA novel electrocardiographic index Tend–P/(PQxAge) demonstrates a high diagnostic accuracy for the diagnosis of DD and yields a substantial added value when combined with the LAESVI.

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Section: Discussionsupporting

confidence: 69%

A Novel Electrocardiographic Index for the Diagnosis of Diastolic Dysfunction

et al. 2013

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“…[19][20][21][22][23][24] However, in our study, we observed HFPEF in 42% of the patients (mean age, 56.11 ±6.24 years) with hypertension and the mildest form of diastolic dysfunction, namely, impaired relaxation. To the best of our knowledge, our study is the first to The presence of isolated HFPEF in a substantial number of patients with impaired relaxation indicates that this stage of diastolic dysfunction is not necessarily as mild as is commonly believed.…”

Section: -32contrasting

confidence: 54%

Incidence of chronic heart failure with preserved left ventricular ejection fraction in patients with hypertension and isolated mild diastolic dysfunction

Brzyżkiewicz¹,

Konduracka²,

Gajos³

et al. 2016

Polish Archives of Internal Medicine

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“…Furthermore, we specifically measured tissue Doppler of the septal annulus which may overestimate the severity of diastolic dysfunction [36]. While other measures of diastolic function are available, such as the indexed left atrial volume and/or the ratio of the diastolic reversal in pulmonary inflow to mitral A inflow duration [37,38], pulmonary inflow is difficult to obtain reliably in critically ill patients, and in our cohort, left atrial dilatation was extremely rare. The relatively small number of patients in patient subgroups underscores the importance of much larger sample sizes for studies in critical care echocardiography than have been reported to date.…”

Section: Discussionmentioning

confidence: 99%

Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study

et al. 2012

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BackgroundPatients with severe sepsis or septic shock often exhibit significant cardiovascular dysfunction. We sought to determine whether severity of diastolic dysfunction assessed by transthoracic echocardiography (TTE) predicts 28-day mortality.MethodsIn this prospective, observational study conducted in two intensive care units at a tertiary care hospital, 78 patients (age 53.2 ± 17.1 years; 51% females; mean APACHE II score 23.3 ± 7.4) with severe sepsis or septic shock underwent TTE within 6 h of ICU admission, after 18 to 32 h, and after resolution of shock. Left ventricular (LV) diastolic dysfunction was defined according to modified American Society of Echocardiography 2009 guidelines using E, A, and e’ velocities; E/A and E/e’; and E deceleration time. Systolic dysfunction was defined as an ejection fraction < 45%.ResultsTwenty-seven patients (36.5%) had diastolic dysfunction on initial echocardiogram, while 47 patients (61.8%) had diastolic dysfunction on at least one echocardiogram. Total mortality was 16.5%. The highest mortality (37.5%) was observed among patients with grade I diastolic dysfunction, an effect that persisted after controlling for age and APACHE II score. At time of initial TTE, central venous pressure (CVP) (11+/- 5 mmHg) did not differ among grades I-III, although patients with grade I received less intravenous fluid.ConclusionsLV diastolic dysfunction is common in septic patients. Grade I diastolic dysfunction, but not grades II and III, was associated with increased mortality. This finding may reflect inadequate fluid resuscitation in early sepsis despite an elevated CVP, suggesting a possible role for TTE in sepsis resuscitation.

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Grading diastolic left ventricular function

Cited by 5 publications

References 9 publications

A Novel Electrocardiographic Index for the Diagnosis of Diastolic Dysfunction

A Novel Electrocardiographic Index for the Diagnosis of Diastolic Dysfunction

Incidence of chronic heart failure with preserved left ventricular ejection fraction in patients with hypertension and isolated mild diastolic dysfunction

Diastolic dysfunction and mortality in early severe sepsis and septic shock: a prospective, observational echocardiography study

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