Interstudy heterogeneity of definitions of diastolic dysfunction severely affects reported prevalence

Abstract

AimsThe aim of this article is to examine how the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE) recommendations on the classification of diastolic dysfunction (DDF) are interpreted in the scientific community and to explore how variations in the DDF definition affect the reported prevalence.Methods and resultsA systematic review of studies citing the EACVI/ASE consensus document ‘Recommendations for the evaluation of left ventricular diastolic function by echocardiography’ was performed. The definition of DDF used in each study was recorded. Subsequently, several possible interpretations of the EACVI/ASE classification scheme were used to obtain DDF prevalence in a community-based sample (n = 714). In the systematic review, 60 studies were included. In 13 studies, no specification of DDF definition was presented, a one-level classification tree was used in 13, a two-level classification tree in 18, and in the remaining 16 studies, a DDF definition was presented but no grading of DDF was performed. In 17 studies, the DDF definition relied solely on early diastolic tissue velocity and/or left atrial size. In eight of these studies, a single parameter was used, in two studies the logical operator AND was used to combine two or more parameters, and the remaining seven studies used the logical operator OR. The resulting prevalence of DDF in the community-based sample varied from 12 to 84%, depending on the DDF definition used.ConclusionA substantial heterogeneity of definitions of DDF was evident among the studies reviewed, and the different definitions had a substantial impact on the reported prevalence of DDF.

Implications of myocardial dysfunction before and after aortic valve intervention

“…In our fourth study, we found that 22% (54/247) of patients had signs of high preoperative LV filling pressures. This proportion might appear somewhat low, compared to those reported in other studies 61,142,143 . This discrepancy could be due to differences in cohorts, the types of procedure, referral patterns, and different indices used for classifying diastolic dysfunction 56 .…”

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“…26,45,48,81Y84 The same is not true for the diagnosis of diastolic dysfunction 81,85 since there is a substantial heterogeneity in defining diastolic dysfunction even among cardiologists. The measurement of diastolic dysfunction requires expertise and training beyond the scope of a qualitative or semiqualitative examination 86,87 .…”

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“…Selmeryd et al examined how the classifications of DD by the European Association of Cardiovascular Imaging and the American Society of Echocardiography are used and how these variations affect the reported prevalence of DD in the community. 96 The problem with the European Association of Cardiovascular Imaging/American Society of Echocardiography algorithms is that there are no guidelines to deal with discordant measurements, leading to confusion when cardiologists were given the same premeasured variables. 97,98 There were also large differences in HFPEF…”

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