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Validity of revised Doppler echocardiographic algorithms and composite clinical and angiographic data in diagnosis of
Kofo O Ogunyankin1, Gary W Burggraf, Ademola K Abiose
1Division of Cardiology, Queens University, Kingston General Hospital, Kingston, Ontario, Canada. koo@post.queensu.ca
Insights
Echocardiographic and clinical methods for grading diastolic function show similar accuracy in identifying elevated left ventricular filling pressures. A standardized clinical algorithm effectively identifies patients with abnormal diastolic function, comparable to echocardiography.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Echocardiographic indices for diastolic function grading have limited diagnostic concordance and discriminatory value.
- Significant overlap between indices hinders single group assignment for many patients.
- Current methods necessitate validation against more definitive measures like cardiac catheterization.
Purpose of the Study:
- To assess the relative validity of echocardiographic and clinical algorithms for grading diastolic function.
- To compare the accuracy of these algorithms in identifying abnormal left ventricular (LV) diastolic pressures.
- To evaluate a new three-stage classification for diastolic function that omits the pseudonormal category.
Main Methods:
- 115 patients underwent echocardiography prior to left ventricular (LV) pressure measurements via cardiac catheterization.
- Diastolic function was classified using traditional four-stage and a novel three-stage system.
- Clinical and angiographic data were used to generate a probability score for abnormal diastolic function.
- Measured LV diastolic pressures were compared against expected pressures derived from both classification systems.
Main Results:
- Both four-stage and three-stage echocardiographic classifications yielded interchangeable results regarding mean diastolic pressures.
- The three-stage classification identified severe diastolic dysfunction, with 88% classified as high probability clinically (mean LV pre-A pressure >12 mmHg).
- Patients classified as low probability clinically or normal echocardiographically exhibited mean LV pre-A pressures <11 mmHg.
Conclusions:
- A standardized clinical algorithm for assessing diastolic function probability is as effective as echocardiographic methods in identifying elevated LV filling pressures.
- Both echocardiographic and clinical approaches can reliably stratify patients based on diastolic dysfunction severity.
- These findings support the use of clinical assessment as a valuable tool in diagnosing diastolic dysfunction.
Background:
Commonly used echocardiographic indices for grading diastolic function predicated on mitral inflow Doppler analysis have a poor diagnostic concordance and discriminatory value. Even when combined with other indices, significant overlap prevents a single group assignment for many subjects. We tested the relative validity of echocardiographic and clinical algorithms for grading diastolic function in patients undergoing cardiac catheterization.
Method:
Patients (n = 115), had echocardiograms immediately prior to measuring left ventricular (LV) diastolic (pre-A, mean, end-diastolic) pressures. Diastolic function was classified into the traditional four stages, and into three stages using a new classification that obviates the pseudonormal class. Summative clinical and angiographic data were used in a standardized fashion to classify each patient according to the probability for abnormal diastolic function. Measured LV diastolic pressure in each patient was compared with expected diastolic pressures based on the clinical and echocardiographic classifications.
Result:
The group means of the diastolic pressures were identical in patients stratified by four-stage or three-stage echocardiographic classifications, indicating that both classifications schemes are interchangeable. When severe diastolic dysfunction is diagnosed by the three-stage classification, 88% and 12%, respectively, were clinically classified as high and intermediate probability, and the mean LV pre-A pressures was >12 mmHg (P < 0.005). Conversely, the mean LV pre-A pressure in the clinical low probability or echocardiographic normal groups was <11 mmHg.
Conclusion:
Use of a standardized clinical algorithm to define the probability of diastolic function identifies patients with elevated LV filing pressure to the same extent as echocardiographic methods.
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