Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography

Nagueh, Sherif F.; Appleton, Christopher P.; Gillebert, Thierry C.; Marino, Paolo; Oh, Jae K.; Smiseth, Otto A.; Waggoner, Alan D.; Flachskampf, Frank A.; Pellikka, Patricia A.; Evangelista, Arturo

doi:10.1016/j.echo.2008.11.023

Cited by 3,476 publications

(3,456 citation statements)

References 183 publications

(277 reference statements)

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“…Based on the current findings, 3D three-directional VE MRI with retrospective valve tracking not only provides more accurately transmitral flow volumes and regurgitation fraction as compared to 2D one-directional VE MRI, but the 3D VE MRI approach also better discriminates restrictive transmitral flow when Doppler echocardiography is used as the reference standard. This is important for the clinical evaluation of symptoms, optimization of therapy, and prediction of prognosis in heart failure patients (15,20).…”

Section: Discussionmentioning

confidence: 99%

Left ventricular diastolic function assessment from three‐dimensional three‐directional velocity‐encoded MRI with retrospective valve tracking

Brandts

Bertini

Dijk

et al. 2011

Magnetic Resonance Imaging

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Purpose: To compare parameters describing left ventricular (LV) diastolic function obtained with three-dimensional (3D) three-directional velocity-encoded (VE) MRI with retrospective valve tracking and two-dimensional (2D) one-directional VE MRI in patients with ischemic heart failure. Second, to compare classification of LV diastolic function, and in particular for discriminating restrictive filling patterns, with both MRI techniques versus Doppler echocardiography. Materials and Methods:The 3D and 2D VE MRI early (E) and atrial (A) peak flow rate indices, determined from transmitral waveform analyses, were compared. Also, net forward flow volume per cycle and transmitral regurgitation fraction were determined. Agreement in classifying diastolic filling patterns between 3D and 2D VE MRI versus Doppler echocardiography was evaluated using kappa statistics.Results: The 3D three-directional VE MRI with retrospective valve tracking was statistically significantly different from 2D one-directional VE MRI for net forward flow volume and regurgitation fraction through the mitral valve and all parameters describing the diastolic waveform filling pattern, except for the E deceleration time and E/A filling ratio. Kappa-agreement between 3D three-directional VE MRI with retrospective valve tracking and echocardiography for classifying diastolic filling patterns was superior to 2D one-directional VE MRI and echocardiography (i.e., k ¼ 0.91 versus k ¼ 0.79, respectively). Conclusion:The 3D three-directional VE MRI with retrospective valve tracking better describes LV diastolic function as compared to 2D one-directional VE MRI in patients with ischemic heart failure.

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Section: Discussionmentioning

confidence: 99%

Left ventricular diastolic function assessment from three‐dimensional three‐directional velocity‐encoded MRI with retrospective valve tracking

Brandts

Bertini

Dijk

et al. 2011

Magnetic Resonance Imaging

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“…amd M.G.K. ; Data S2; Table S1) 27. Baseline demographics and clinical characteristics of the study population were collected by the Duke Databank for Cardiovascular Disease using previously described methods 28.…”

Section: Methodsmentioning

confidence: 99%

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Hunter

Kelly

McGarrah

et al. 2016

JAHA

186

137

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BackgroundMetabolic impairment is an important contributor to heart failure (HF) pathogenesis and progression. Dysregulated metabolic pathways remain poorly characterized in patients with HF and preserved ejection fraction (HFpEF). We sought to determine metabolic abnormalities in HFpEF and identify pathways differentially altered in HFpEF versus HF with reduced ejection fraction (HFrEF).Methods and ResultsWe identified HFpEF cases, HFrEF controls, and no‐HF controls from the CATHGEN study of sequential patients undergoing cardiac catheterization. HFpEF cases (N=282) were defined by left ventricular ejection fraction (LVEF) ≥45%, diastolic dysfunction grade ≥1, and history of HF; HFrEF controls (N=279) were defined similarly, except for having LVEF <45%. No‐HF controls (N=191) had LVEF ≥45%, normal diastolic function, and no HF diagnosis. Targeted mass spectrometry and enzymatic assays were used to quantify 63 metabolites in fasting plasma. Principal components analysis reduced the 63 metabolites to uncorrelated factors, which were compared across groups using ANCOVA. In basic and fully adjusted models, long‐chain acylcarnitine factor levels differed significantly across groups (P<0.0001) and were greater in HFrEF than HFpEF (P=0.0004), both of which were greater than no‐HF controls. We confirmed these findings in sensitivity analyses using stricter inclusion criteria, alternative LVEF thresholds, and adjustment for insulin resistance.ConclusionsWe identified novel circulating metabolites reflecting impaired or dysregulated fatty acid oxidation that are independently associated with HF and differentially elevated in HFpEF and HFrEF. These results elucidate a specific metabolic pathway in HF and suggest a shared metabolic mechanism in HF along the LVEF spectrum.

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“…Left atrial (LA) volume was measured using the biplane area‐length method. LV diastolic function LVDF assessments used mitral valve pulsed wave Doppler and Doppler tissue imaging at rest and during the Valsalva maneuver 34. LV outflow tract diameter and pulse wave Doppler were used to calculate stroke volume and cardiac output.…”

Section: Methodsmentioning

confidence: 99%

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

Korcarz

Benca

Barnet

et al. 2016

JAHA

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BackgroundThe cardiovascular effects of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) patients are not clear because of confounding by comorbid conditions.Methods and ResultsProspective interventional study of PAP therapy and withdrawal. Apnea Hypopnea Index (AHI; events/hour of sleep) was determined from polysomnography. Central aortic blood pressures (BPs), Aortic Augmentation Index (AAIx), and central (PWV c‐f) and peripheral pulse wave (PWV c‐r) velocities were determined by applanation tonometry. Echocardiography and brachial artery reactivity testing were performed at baseline, after 4 and 12 weeks of PAP therapy, and 1 week after PAP withdrawal. The 84 participants were mean (SD) 41.1 (7.6) years old and had 39.8 (24.5) AHI events/hour. After 4 weeks post‐PAP initiation and sustained after 12 weeks, subjects experienced decreases in central systolic BP (P=0.008), diastolic BP, mean BP, AAIx, and PWV c‐r, and brachial artery dilation (all P<0.001), as well as improvements in left ventricular diastolic function and systemic and pulmonary vascular resistance. In adjusted models, PAP use (hours/night) predicted reductions in diastolic BP (β=−0.65 [SE, 0.32] mm Hg/hour; P=0.045), AAIx (β=−0.53 [0.27] %/hour; P=0.049) and PWV c‐r (β=−0.13 [0.05] m·s−1/hour; P=0.007), and improved brachial artery flow‐mediated dilation (β=0.31 [0.14] %/hour use; P=0.015). After 1 week of PAP withdrawal, brachial diameter, diastolic BP, mean BP, AAIx, and heart rate increased (P≤0.05).Conclusions PAP therapy reduces arterial tone and improves endothelial and diastolic function in young to middle‐aged adults. This positive effect is observed after 4 weeks and depends on hours of use, but reverts quickly with PAP withdrawal.Clinical Trial RegistrationURL: https://clinicaltrials.gov/. Unique identifier: NCT01317329.

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Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography

Cited by 3,476 publications

References 183 publications

Left ventricular diastolic function assessment from three‐dimensional three‐directional velocity‐encoded MRI with retrospective valve tracking

Left ventricular diastolic function assessment from three‐dimensional three‐directional velocity‐encoded MRI with retrospective valve tracking

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Treatment of Obstructive Sleep Apnea in Young and Middle‐Aged Adults: Effects of Positive Airway Pressure and Compliance on Arterial Stiffness, Endothelial Function, and Cardiac Hemodynamics

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