Practical Impact of New Diastolic Recommendations on Noninvasive Estimation of Left Ventricular Diastolic Function and Filling Pressures

Sorrentino, Regina; Esposito, Roberta; Santoro, Ciro; Vaccaro, Andrea; Cocozza, Sara; Scalamogna, Maria; Lembo, Maria; Luciano, F; Santoro, Alessandro; Trimarco, Bruno; Galderisi, Maurizio

doi:10.1016/j.echo.2019.08.013

Cited by 29 publications

(33 citation statements)

References 34 publications

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“…While JOHANSEN algorithm allowed grading all patients, ASE/EACVI and OH failed to do so in about 10% individuals. Our data incidentally showed that using the updated ASE/EACVI results into a significant reduction of patients with undetermined DF grading in comparison with the 2009 version [ 4 ], consistent with Sorrentino et al [ 29 ]. The main difference from that study, however, is that we used Valsalva maneuver and PVF analysis in all patients but S0HF individuals.…”

Section: Discussionsupporting

confidence: 91%

“…We have previously shown a significant lack of harmony among the 2009 ASE/EACVI classification and other validated classifications [ 1 , 2 , 3 , 4 ]. Since then, ASE/EACVI guidelines have been substantially revised, resulting in significant differences when integrally applied (i.e., including the concept of “myocardial disease”) [ 29 ]. Indeed, comparing our present data with those originally obtained (i.e., SAHF and SBHF) [ 1 ], we could identify a significantly increased prevalence of normal DF and grade I DD, with a clear reduction in grade II and III DD [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms—A Primary Care Study

et al. 2020

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Background: Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number. Methods: We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without (n = 644) or with (n = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a’-ratio (LAVi/a’) over indeterminate grading was assessed. Results: The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a’, with the latter being the single most effective parameter. Conclusion: Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a’ emerges as a simple and effective approach to this aim.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms—A Primary Care Study

et al. 2020

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“…6,7 Because our goal was to test the diagnostic ability of VMT scoring, not to validate the recommended algorithm, we automatically classified diastolic function using the four key variables and did not take into account supplementary variables, such as pulmonary vein flow and Valsalva DE/A ratio, in line with a previous study. 12 Therefore, patients showing monomorphic transmitral flow due to sinus tachycardia or ventricular arrhythmia were judged as indeterminate on the basis of unavailable E/A ratio. In patients in atrial fibrillation (AF), peak systolic TR velocity > 2.8 m/sec and E/e 0 ratio $ 11 were used in the algorithm to determine LVFP elevation.…”

Section: Echocardiographic Examinationmentioning

confidence: 99%

Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure

Murayama

Iwano

Nishino

et al. 2021

Journal of the American Society of Echocardiography

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Background: When left ventricular filling pressure (LVFP) increases, the mitral valve opens early and precedes tricuspid valve opening in early diastole. The authors hypothesized that a visually assessed time sequence of atrioventricular valve opening could become a new marker of elevated LVFP. The aim of this study was to test the diagnostic ability of a novel echocardiographic scoring system, the visually assessed time difference between mitral valve and tricuspid valve opening (VMT) score, in patients with heart failure.Methods: One hundred nineteen consecutive patients who underwent cardiac catheterization within 24 hours of echocardiographic examination were retrospectively analyzed as a derivation cohort. In addition, a prospective study was conducted to validate the diagnostic ability of the VMT score in 50 patients. Elevated LVFP was defined as mean pulmonary artery wedge pressure (PAWP) $ 15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0 = tricuspid valve first, 1 = simultaneous, 2 = mitral valve first). When the inferior vena cava was dilated, 1 point was added, and VMT score was ultimately graded as 0 to 3. Cardiac events were recorded for 1 year after echocardiography.Results: In the derivation cohort, PAWP was elevated with higher VMT scores (score 0, 10 6 5; score 1, 12 6 4; score 2, 22 6 8; score 3, 28 6 4 mm Hg; P < .001, analysis of variance). VMT score $ 2 predicted elevated PAWP with accuracy of 86% and showed incremental predictive value over clinical variables and guidelinerecommended diastolic function grading. These observations were confirmed in the prospective validation cohort. Importantly, VMT score $ 2 discriminated elevated PAWP with accuracy of 82% in 33 patients with monophasic left ventricular inflow in the derivation cohort. Kaplan-Meier analysis demonstrated that patients with VMT scores $ 2 were at higher risk for cardiac events than those with VMT scores # 1 (P < .001).Conclusions: VMT scoring could be a novel additive marker of elevated LVFP and might also be associated with adverse outcomes in patients with heart failure.

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“…Patients with coronary artery disease and multiple wall motion abnormalities have structural heart disease as well. Consideration of myocardial disease will lead to higher incidence of diastolic dysfunction than relying solely on mitral inflow and mitral annulus diastolic velocities as shown in a recent study 6 …”

Section: Ase/eacvi Guidelines For Evaluation Of LV Diastolic Funmentioning

confidence: 98%

“…Consideration of myocardial disease will lead to higher incidence of diastolic dysfunction than relying solely on mitral inflow and mitral annulus diastolic velocities as shown in a recent study. 6 In the absence of myocardial disease, 4 echocardiographic signals are scrutinized including early diastolic velocity at septal and lateral sides of the mitral annulus (e'), biplane LA maximum volume index, ratio of peak mitral E (early diastolic) velocity to the average of septal and lateral e' velocities, and peak TR velocity (from multiple windows so as to record the highest velocity). locities and E/A ratio with Valsalva, amplitude, and peak velocity of atrial reversal signal in pulmonary veins, comparison of mitral inflow pattern with tricuspid inflow velocities (with respect to E/A ratio), and the presence of L wave velocity (≥50 cm/s) in mitral inflow.…”

Section: 016 a S E/e Ac VI G U Ideline S For E Valuati On Of Lv Dmentioning

confidence: 99%

Diastology: 2020‐A practical guide

Nagueh

2020

Echocardiography

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Left ventricular (LV) diastolic function can be most conveniently assessed by echocardiography which provides reliable assessments of LV structure and function. Most patients with structural heart disease have variable degrees of myocardial dysfunction. LV structural changes as pathologic hypertrophy and systolic functional abnormalities as depressed LV long‐axis systolic function are associated with diastolic dysfunction. The recognition of structural abnormalities and abnormal LV long‐axis function as indices of diastolic dysfunction is an important difference between 2016 and 2009 guidelines. In addition, there are other Doppler findings indicative of diastolic dysfunction and abnormally elevated LV filling pressures. In the absence of clinical, 2D echocardiographic, and specific Doppler indices of diastolic dysfunction, mitral annulus early diastolic velocity (e’), left atrium (LA) maximum volume index, peak velocity of tricuspid regurgitation jet by continuous‐wave Doppler, and ratio of mitral inflow early diastolic velocity to e’ velocity can be used to draw inferences about LV diastolic function. In the presence of diastolic dysfunction, mean LA pressure and grade of diastolic dysfunction should be determined. When LA pressure at rest is normal, it is reasonable to proceed to diastolic stress testing in an attempt to identify patients with dyspnea due to heart failure. There are specific algorithms recommended in patients with atrial fibrillation, moderate or severe mitral annular calcification, and noncardiac pulmonary hypertension.

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Practical Impact of New Diastolic Recommendations on Noninvasive Estimation of Left Ventricular Diastolic Function and Filling Pressures

Cited by 29 publications

References 34 publications

Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms—A Primary Care Study

Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms—A Primary Care Study

Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure

Diastology: 2020‐A practical guide

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