A comparative analysis of British and American Society of Echocardiography recommendations for the assessment of left ventricular diastolic function

Abstract

At present there are two recognised guidelines for the echocardiographic assessment of left ventricular diastolic function provided by the British Society of Echocardiography and American Society of Echocardiography/European Association of Cardiovascular Imaging. However, no direct comparison of these guidelines has been performed to establish whether they provide similar diastolic grading. One hundred and eighty-nine consecutive patients in sinus rhythm who underwent transthoracic echocardiography for a primary indication of either heart failure assessment or assessment of left ventricular systolic function were extracted from our database (McKesson Cardiology). Left ventricular diastolic function assessment was performed using both guidelines and the results were compared. Chi-square, Kappa score and one-way ANOVA were used to evaluate the data at a level of P < 0.05. The most frequent outcome was unclassifiable diastolic function with significantly more patients being labelled unclassified with the British compared to American guidelines (47.4 vs 20.5%, P < 0.0001). Having excluded all unclassifiable patients, a significant difference still existed between the two guidelines with a higher proportion of grade one outcomes awarded by the ASE/EACVI guidelines. When grading subcategories were individually compared, there was significantly more grade one diastolic gradings awarded by American compared to the British guidelines (40.7 vs 20.1%, P < 0.0001). In 47% of patients it was not possible to grade diastolic function using the British guidelines, compared to 21% using the American guidelines. For those patients where grading was possible, there was a significant difference in patients classified with normal and grade one diastolic function when using British and American guidelines.

Diastolic dysfunction and mortality in 436 360 men and women: the National Echo Database Australia (NEDA)

“…Examination of these individual markers is clinically relevant, since an indeterminate classification using the ESC/EACVI algorithm was common (affecting 21.5% of individuals overall and 62.2% of the reduced LVEF category), raising a clinical dilemma if the guideline recommendations are used in isolation. Our finding of a frequent indeterminate classification is similar to other studies, 7 , 8 , 14 although after exclusion of patients with cardiomyopathy, valvular heart disease, and non-sinus rhythm, indeterminate diastolic function is less frequently allocated. Since DD is associated with future HF and mortality, 15 , 16 allocation to indeterminate diastolic function has clinical relevance, especially considering our demonstration of increased mortality in the indeterminate preserved LVEF groups, and a similar demonstration by Liang et al .…”

“…For example, it has been reported that between 20% and 50% of patients have ‘indeterminate’ diastolic function if guideline algorithms are applied. 7 , 8 Moreover, normal age-related changes are not considered. In this context identifying high-risk individuals with DD remains a priority.…”

Prevalence and significance of isolated left ventricular non-compaction phenotype in normal black Africans using echocardiography

“… Perfusion of the intertrabecular recesses from the LV cavity. Differentiation between false chords, aberrant bands, and trabeculations in the apical four-chamber view, as well as atypical views to obtain the best image quality [1] , [15] . …”

Machine Learning Augmented Echocardiography for Diastolic Function Assessment

“…Further real-world clinical data from Europe (1,000 individuals), Britain (189 individuals), Asia (57,630 individuals), America (866 individuals), and Canada (71,727 individuals), show that even after excluding patients with diastology-confounding factors, between 11 and 22% of scans are labelled indeterminate ( 5 , 18 , 19 , 21 , 22 ). A pertinent limitation of the literature base collectively is that a breakdown of reasons for indeterminate grading is often not presented.…”