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

Abstract

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.

Performance of non‐invasive myocardial work to predict the first hospitalization for de novo heart failure with preserved ejection fraction

“…Accordingly to ASE/EACVI guidelines, echocardiographic assessment is the first pivotal step for the characterization of the diastolic dysfunction and estimation of LV filling pressure 2 . Nevertheless, the performance of conventional parameters and algorithms is suboptimal, leaving a percentage of about 15% of patients with indeterminate diagnosis 2–5 . The persistence of a diagnostic “grey zone”, together with an increased epidemiological burden of conditions predisposing to HFpEF, sparked the search for novel echocardiographic parameters.…”

“… 2 Nevertheless, the performance of conventional parameters and algorithms is suboptimal, leaving a percentage of about 15% of patients with indeterminate diagnosis. 2 , 3 , 4 , 5 The persistence of a diagnostic “grey zone”, together with an increased epidemiological burden of conditions predisposing to HFpEF, sparked the search for novel echocardiographic parameters. In this regard, LARS, measuring passive LA stretch, turned out to be a sensitive marker of LV diastolic dysfunction.…”

Left atrial ejection fraction is an indicator of left ventricular diastolic function

“…In a primary care setting, echocardiographic reports of 1158 outpatients were retrospectively analyzed and the percentage of indeterminate cases was 9%. The authors suggest most of these patients can be reclassified using conventional echocardiography [18].…”