Impact of Changes in Consensus Diagnostic Recommendations on the Echocardiographic Prevalence of Diastolic Dysfunction

Huttin, Olivier; Fraser, Alan G.; Coiro, Stefano; Bozec, Erwan; Selton‐Suty, Christine; Lamiral, Zohra; Frikha, Zied; Rossignol, Patrick; Zannad, Faı̈ez; Girerd, Nicolas

doi:10.1016/j.jacc.2017.04.039

Cited by 55 publications

(51 citation statements)

References 5 publications

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“…Current echocardiographic criteria used to diagnose HFpEF lack sensitivity, in part because of the inability to accurately measure exercise filling pressure elevation . It is therefore noteworthy that LA reservoir strain and estimated LA compliance were the most predictive measures of HFpEF defined by rest and exercise haemodynamics.…”

Section: Discussionmentioning

confidence: 99%

Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction

Reddy

Obokata

Egbe

et al. 2019

European J of Heart Fail

178

175

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Aims Left atrial (LA) function is impaired in heart failure with preserved ejection fraction (HFpEF) and predicts disease severity and risk of adverse outcome. We sought to evaluate whether LA strain could enhance diagnosis of HFpEF. Methods and results Consecutive patients with unexplained exertional dyspnoea and image quality suitable for measuring LA strain underwent invasive cardiopulmonary exercise testing to ascertain the presence of HFpEF or non‐cardiac causes of dyspnoea (NCD). LA reservoir strain was measured in all patients, while LA conduit and booster strain were measured in patients with sinus rhythm. LA strain was measurable in 363 of 378 examinations (96.5%; HFpEF: 238, NCD: 125). LA reservoir strain (29 ± 16% vs. 40 ± 13%, P < 0.0001) and conduit strain (18 ± 10% vs. 22 ± 10%, P = 0.0001) were significantly impaired in HFpEF compared to NCD. Of all echocardiographic indices, LA reservoir strain best discriminated HFpEF from NCD [area under the curve (AUC) 0.719, P < 0.0001], outperforming E/e' (AUC difference +0.117, P < 0.0001), LA enlargement (+0.090, P = 0.001), tricuspid regurgitation velocity > 2.8 m/s (+0.082, P = 0.0085), left ventricular hypertrophy (+0.0159, P < 0.0001) and left ventricular global longitudinal strain (+0.0198, P < 0.0001). Indexing LA reservoir strain to estimated LA pressure (E/e') as a surrogate for LA compliance further improved diagnostic performance (AUC 0.772, P < 0.0001; +0.053 compared to LA reservoir strain alone, P = 0.003). Conclusion Left atrial reservoir strain may provide enhanced diagnostic accuracy beyond conventional echocardiographic measures to discriminate HFpEF from NCD. Further study is required to verify the diagnostic utility of LA strain.

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Section: Discussionmentioning

confidence: 99%

Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction

Reddy

Obokata

Egbe

et al. 2019

European J of Heart Fail

178

175

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“…A population‐based study of 1000 individuals showed lower prevalence of DD applying the 2016 guidelines (1.4% compared to 38.1% with the 2009 guidelines) 26. In the community‐based STANISLAS cohort, prevalence based on the 2016 guidelines was 76% lower compared to 2009 guidelines (1.3% vs 5.7%) 27. A smaller study of 307 Hispanic patients with type 2 diabetes mellitus without symptoms of heart failure found a decrease in DD from 37% (2009 guidelines) to 7% (2016 guidelines) 28.…”

Section: Discussionmentioning

confidence: 97%

Impact of the 2016 ASE/EACVI Guidelines on diastolic function reporting in routine clinical practice

Gopalakrishnan

Biederman

2020

Echocardiography

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Objective: To evaluate the impact of 2016 ASE/EACVI guidelines on Diastolic Function (DF) reporting during routine clinical practice. Methods: Transthoracic echos performed 9 months before and 18 months after the 2016 guidelines (DF2016) were retrospectively analyzed. Results: Twenty thousand eight hundred forty three echos performed between July 1, 2015, and September 30, 2017, were analyzed. Quarterly trends showed a stable proportion of normal DF (nDF), diastolic dysfunction (DD), indeterminate DF (DF-I),and nonreported DF (DF-NR) for 3 quarters preceding DF2016. After DF2016 release, reporting of DD decreased by 57% (P < .001), nDF increased by 76% (P < .001), DF-NR increased by 266% (P < .001), and DF-I did not change significantly (P = .40).Grade 1 DD decreased by 64% (P < .001), grade 2 DD decreased by 51% (P < .001), and grade 3 DD did not change significantly (P = .18). Provider level analysis showed increased heterogeneity in grade 1 DD reporting and decreased heterogeneity in DD grades 2 or higher, after DF2016. Systolic dysfunction reporting remained relatively stable (22%→21%→20%) compared to a significant decrease in isolated DD (35%→21%→10%). Conclusion:The 2016 guidelines update has impacted DF reporting patterns significantly. The likelihood of reporting DD decreased significantly, especially for grades 1 and 2. Inter-provider heterogeneity in DF reporting improved for grades 2 and 3 but worsened for grade 1. There was more than threefold increase in failure to report DF, suggesting a decrease in provider confidence. K E Y W O R D S2009 ASE/ESE guidelines, 2016 ASE/EACVI guidelines update, diastolic dysfunction

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“…Third, while echocardiographic assessment of DD remains a matter of debate, the definition used for this analysis has nonetheless been shown to be reproducible and easily assessable. 13 Fourth, the biomarkers herein were measured at 1 month post-MI, as already reported 9,16 ; hence, they do not reflect the acute event kinetics but may better reflect cardiac remodelling in the short-term post-MI phase. Fifth, the echocardiographic and biomarker assessment was not performed simultaneously; hence, the correlation between the biomarker levels and echocardiographic parameters is suboptimal.…”

Section: Study Limitationsmentioning

confidence: 93%

“…In contrast, the majority of patients with abnormal diastolic function indices exhibited substantial fibrosis regardless of underlying cause. [10][11][12] Despite the lack of definitive consensus for the definition of DD, 13 the echocardiographic parameters used to assess DD (such as septal e 0 , lateral e 0 , and left atrial volume) have been shown to be associated with natriuretic peptides and long-term outcomes. 9 However, an increase in LV end-diastolic volume may be misleading in the setting of preserved left ventricular ejection fraction (LVEF).…”

Section: Introductionmentioning

confidence: 99%

“…10,8 In a model of age-associated adverse cardiac remodelling, the LV end-diastolic volume was shown to markedly decrease with age, despite altered strain patterns reflecting both systolic dysfunction and DD, 11 suggesting that DD is a better reflection of adverse remodelling compared with an increase in LV end-diastolic volume in the setting of a preserved ejection fraction (LVEF may actually increase in this context). [10][11][12] Despite the lack of definitive consensus for the definition of DD, 13 the echocardiographic parameters used to assess DD (such as septal e 0 , lateral e 0 , and left atrial volume) have been shown to be associated with natriuretic peptides and long-term outcomes. 14 Biomarkers such as brain natriuretic peptide (BNP) and galectin-3 (Gal-3) have also been studied in the acute MI setting and have been associated with adverse remodelling and prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Echocardiographic diastolic function evolution in patients with an anterior Q‐wave myocardial infarction: insights from the REVE‐2 study

et al. 2018

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AimsMyocardial fibrosis plays a key role in the development of adverse left ventricular remodelling after myocardial infarction (MI). This study aimed to determine whether the circulating levels of BNP, collagen peptides, and galectin‐3 are associated with diastolic function evolution (both deterioration and improvement) at 1 year after an anterior MI.Methods and resultsThe REVE‐2 is a prospective multicentre study including 246 patients with a first anterior Q‐wave MI. Echocardiographic assessment was performed at hospital discharge and ±1 year after MI. BNP, galectin‐3, and collagen peptides were measured ±1 month after MI. Left ventricular diastolic dysfunction (DD) was defined according to the presence of at least two criteria of echocardiographic parameters: septal e′ < 8 cm/s, lateral e′ < 10 cm/s, and left atrial volume ≥ 34 mL/m2. At baseline, 87 (35.4%) patients had normal diastolic function and 159 (64.6%) patients had DD. Follow‐up of 61 patients among the 87 patients with normal diastolic function at baseline showed that 22 patients (36%) developed DD at 1 year post‐MI. The circulating levels of amino‐terminal propeptide of type III procollagen > 6 mg/L [odds ratio (OR) = 5.29; 95% confidence interval (CI) = 1.05–26.66; P = 0.044], galectin‐3 > 13 μg/L (OR = 5.99; 95% CI = 1.18–30.45; P = 0.031), and BNP > 82 ng/L (OR = 10.25; 95% CI = 2.36–44.50; P = 0.002) quantified at 1 month post‐MI were independently associated with 1 year DD. Follow‐up of the 137 patients with DD at baseline among the 159 patients showed that 36 patients (26%) had a normalized diastolic function at 1 year post‐MI. Patients with a BNP > 82 ng/L were less likely to improve diastolic function (OR = 0.06; 95% CI = 0.01–0.28; P = 0.0003).ConclusionsThe present study suggests that circulating levels of amino‐terminal propeptide of type III procollagen, galectin‐3, and BNP may be independently associated with new‐onset DD in post‐MI patients.

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Impact of Changes in Consensus Diagnostic Recommendations on the Echocardiographic Prevalence of Diastolic Dysfunction

Cited by 55 publications

References 5 publications

Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction

Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction

Impact of the 2016 ASE/EACVI Guidelines on diastolic function reporting in routine clinical practice

Echocardiographic diastolic function evolution in patients with an anterior Q‐wave myocardial infarction: insights from the REVE‐2 study

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