Patients with high left ventricular filling pressure may be missed applying 2016 echo guidelines: a pilot study

Michaud, Matthieu; Maurin, V.; Simon, Marc A.; Chauvel, Christophe; Bogino, E.; Abergel, Éric

doi:10.1007/s10554-019-01667-w

Cited by 16 publications

(12 citation statements)

References 18 publications

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“…Uncertainty exists in the diagnostic criteria of HFpEF in the current guidelines. The diagnosis of HFpEF depends on the level of natriuretic peptides and echocardiographic data, but the sensitivities of both are quite low [10][11][12]. In particular, natriuretic peptides might have limited value in evaluating HFpEF [11].…”

Section: Diagnosis Of Hfpefmentioning

confidence: 99%

Heart failure with preserved ejection fraction: insights from recent clinical researches

Kim

Park

2020

Korean J Intern Med

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Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for nearly half of the cases of HF and its incidence might be increasing with the aging society. Patients with HFpEF present with significant symptoms, including exercise intolerance, impaired quality of life, and have a poor prognosis as well as frequent hospitalization and increased mortality compared with HF with reduced ejection fraction. The concept of HFpEF is still evolving and may be a virtual complex rather than a real systemic disorder. Thus, beyond solely targeting cardiac abnormalities management strategies need to be extended, such as left ventricular diastolic dysfunction. In this review, we examine new diagnostic algorithms, pathophysiology, current management status, and ongoing trials based on heterogeneous pathophysiology and etiology in HFpEF.

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Section: Diagnosis Of Hfpefmentioning

confidence: 99%

Heart failure with preserved ejection fraction: insights from recent clinical researches

Kim

Park

2020

Korean J Intern Med

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“…Balaney et al17 found 2016 guidelines were less sensitive (0.69 vs 0.79) for diagnosing grade 2 or higher DD (elevated filling pressure). Michaud et al30 also reported 2016 guidelines may miss some patients with grade 2 or higher DD. The decrease in sensitivity for grade 1 DD may be even more marked, but difficult to confirm hemodynamically, as invasive studies with pressure–volume relationships and estimation of tau may be needed.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have found lower sensitivity for the 2016 guidelines in patients with elevated filling pressures as well. Michaud et al found 26 of 58 patients with Ar‐A duration >30 ms (suggestive of elevated left ventricular filling pressure) were classified as normal left ventricular filling pressure when applying the 2016 guidelines 30. In addition, the impact of the 2016 guidelines on DF reporting during routine clinical practice has not been well studied so far.…”

Section: Discussionmentioning

confidence: 99%

Impact of the 2016 ASE/EACVI Guidelines on diastolic function reporting in routine clinical practice

Gopalakrishnan

Biederman

2020

Echocardiography

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Objective: To evaluate the impact of 2016 ASE/EACVI guidelines on Diastolic Function (DF) reporting during routine clinical practice. Methods: Transthoracic echos performed 9 months before and 18 months after the 2016 guidelines (DF2016) were retrospectively analyzed. Results: Twenty thousand eight hundred forty three echos performed between July 1, 2015, and September 30, 2017, were analyzed. Quarterly trends showed a stable proportion of normal DF (nDF), diastolic dysfunction (DD), indeterminate DF (DF-I),and nonreported DF (DF-NR) for 3 quarters preceding DF2016. After DF2016 release, reporting of DD decreased by 57% (P < .001), nDF increased by 76% (P < .001), DF-NR increased by 266% (P < .001), and DF-I did not change significantly (P = .40).Grade 1 DD decreased by 64% (P < .001), grade 2 DD decreased by 51% (P < .001), and grade 3 DD did not change significantly (P = .18). Provider level analysis showed increased heterogeneity in grade 1 DD reporting and decreased heterogeneity in DD grades 2 or higher, after DF2016. Systolic dysfunction reporting remained relatively stable (22%→21%→20%) compared to a significant decrease in isolated DD (35%→21%→10%). Conclusion:The 2016 guidelines update has impacted DF reporting patterns significantly. The likelihood of reporting DD decreased significantly, especially for grades 1 and 2. Inter-provider heterogeneity in DF reporting improved for grades 2 and 3 but worsened for grade 1. There was more than threefold increase in failure to report DF, suggesting a decrease in provider confidence. K E Y W O R D S2009 ASE/ESE guidelines, 2016 ASE/EACVI guidelines update, diastolic dysfunction

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“…These studies and others suggest that the E/e’ index is useful in patients with aortic valve stenosis, but a recent study offers a cautionary note. Michaud et al found that 45% of their preoperative patients with coronary artery disease and/or aortic stenosis, who were graded using current consensus criteria to have low filling pressures, had prolonged retrograde pulmonary venous flow suggesting a high LVedp 79 …”

Section: Clinical Factors Affecting the Diagnostic Utility Of E/e’mentioning

confidence: 99%

When does the E/e’ index not work? The pitfalls of oversimplifying diastolic function

2020

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A comprehensive assessment of diastolic function is an integral component of the complete echocardiographic examination of any patient referred with suspected heart failure, irrespective of their left ventricular (LV) systolic function. Diagnostic clues are provided from all modalities including cross-sectional imaging, M-mode echocardiography, and both spectral blood pool and tissue Doppler (or myocardial velocity) recordings. The first Doppler method that was applied to assess LV diastolic function was analysis of the mitral E/A ratio, but it was recognized that a ratio >1 may be ambiguous since it does not

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Patients with high left ventricular filling pressure may be missed applying 2016 echo guidelines: a pilot study

Cited by 16 publications

References 18 publications

Heart failure with preserved ejection fraction: insights from recent clinical researches

Heart failure with preserved ejection fraction: insights from recent clinical researches

Impact of the 2016 ASE/EACVI Guidelines on diastolic function reporting in routine clinical practice

When does the E/e’ index not work? The pitfalls of oversimplifying diastolic function

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