Impact of Updated 2016 ASE/EACVI VIS-À-VIS 2009 ASE Recommendation on the Prevalence of Diastolic Dysfunction and LV Filling Pressures in Patients with Preserved Ejection Fraction

Abstract

BACKGROUND: Assessment of diastolic dysfunction (DD) and left ventricular filling pressures (LVFP) by echocardiography is complex in patients with preserved ejection fraction (EF). The American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) jointly published recommendations in 2016 to simplify the diagnosis and classification of DD and the assessment of LVFP. We aimed to study the impact of the updated 2016 ASE/EACVI guidelines vis-à-vis the 2009 ASE recommendations on prevalence of DD and LVFP in patients with preserved EF. METHODS: Five hundred patients referred to the echocardiography laboratory from March 2020 to May 2020 were analyzed. Patients with left ventricular ejection fraction (LVEF) < 50% were excluded. All patients underwent comprehensive transthoracic echocardiography. DD and LVFP were assessed by the 2016 ASE/EACVI and 2009 ASE recommendations.The concordance between the guidelines was analyzed by kappa coefficient and overall proportion of agreement. RESULTS: Mean age was 53 ± 13 years and 63.4% were men. Prevalence of DD and abnormal LVFP were significantly lower with the 2016 recommendations than with the 2009 recommendations (9.4% vs. 16.8%, p < 0.001 and 8.4% vs. 12.8%, p < 0.05). Patients with Grade 1 DD (100%) and Grade 2 DD (46.4%) were reclassified by the 2016 recommendations. Indeterminate diastolic function (9.8%) was strikingly high according to the 2016 recommendations. The concordance between the two recommendations was moderate (kappa = 0.569). The overall proportion of agreement was 85.4%. CONCLUSIONS: Prevalence of DD and abnormal LV filling pressures were lower with application of the 2016 ASE/EACVI recommendations in patients with preserved EF. There was moderate agreement between the 2009 and 2016 recommendations.

Prevalence and renal prognosis of left ventricular diastolic dysfunction in non-dialysis chronic kidney disease patients with preserved systolic function

“…The lower prevalence of LV diastolic dysfunction in our study vs. previous ones is mainly due to the change of the echocardiographic criteria used to assess LV diastolic function. Similar discrepancy has been detected in the general population [11–14]. Indeed, we found that the prevalence of LV diastolic dysfunction by adopting the 2016 ASE/ESCVI guidelines resulted significantly lower than the prevalence detected using the 2009 ASE guidelines (22.7% vs. 62.1%, respectively) and allowed us to identify and quantify the group of the indeterminate pattern (45.7%).…”

“…This parameter, being less dependent on volume status, is now considered as the most reliable index of diastolic dysfunction at variance with other echocardiographic parameters (e.g. left atrial dilation) [11,36]. This assumption is supported by a previous experimental study in unilateral nephrectomized rats revealing that LV diastolic abnormalities develop prior to the occurrence of changes in eGFR, BP, fluid expansion, and aldosterone activation.…”

“…This complexity has been recognized and therefore led to an update of the echocardiographic algorithm that simplifies the diagnosis of LV diastolic dysfunction in patients with preserved systolic function in order to facilitate the differentiation between normal and abnormal diastolic function [10]. This novel diagnostic approach has generated lower estimates of prevalence in the general population [11–14]. Whether the same held true in CKD patients remains unexplored.…”