Redefining diastolic dysfunction grading: combination of E/A ≤0.75 and deceleration time >140 ms and E/ε' ≥10

Area of Science:

• Cardiology
• Echocardiography
• Diastology

Background:

• Traditional diastolic dysfunction (DD) grading systems have limitations in classifying all patients.
• A proposed new DD grade (E/A ≤0.75, deceleration time >140 ms, E/ε' ≥10) requires further investigation.

Purpose of the Study:

• To investigate left atrial (LA) mechanics in patients with the proposed new DD grade.
• To determine the prognostic impact of this new DD grade on cardiac events.

Main Methods:

• 1,362 patients were stratified using the new DD grading system.
• Two-dimensional speckle-tracking analysis was used to measure LA volumes, strain, and strain rates.
• Patients were followed for cardiac death and major adverse cardiac events.

Main Results:

• The new DD grade was identified in 17% of patients.
• LA volumes were intermediate between impaired relaxation and pseudonormal groups.
• LA booster function was preserved, but LA volumes were enlarged; prognosis was worse than impaired relaxation but similar to pseudonormal DD.

Conclusions:

• The new DD grade is a distinct entity with a significant prognostic impact.
• It is characterized by preserved LA booster function at the expense of LA volume enlargement.
• This classification should be incorporated into routine DD grading.