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Effect of Echocardiographic Grading of Left Ventricular Diastolic Dysfunction by Different Classifications in Primary
Stefano Nistri1, Piercarlo Ballo2, Donato Mele3
1Cardiology Service CMSR Veneto Medica, Altavilla Vicentina, Italy.
Insights
Left ventricular diastolic dysfunction (LVDD) is linked to mortality. This study found LVDD assessment is feasible in primary care, but different grading methods show poor agreement, impacting patient management.
Area of Science:
- Cardiology
- Primary Care Medicine
- Diagnostic Imaging
Background:
- Left ventricular diastolic dysfunction (LVDD) identified by Doppler echocardiography correlates with increased mortality.
- Existing data on LVDD predominantly originates from specialized referral centers, utilizing varied assessment algorithms.
- The clinical utility of LVDD assessment in primary care settings remains underexplored.
Purpose of the Study:
- To evaluate the feasibility of comprehensive LVDD assessment in a primary care outpatient environment.
- To compare the concordance of three distinct methodological approaches for grading LVDD.
- To determine the reliability of LVDD grading across different criteria in a real-world primary care setting.
Main Methods:
- Prospective Doppler echocardiography was performed on 885 consecutive outpatients in sinus rhythm.
- Feasibility of individual LV diastolic indices, including Valsalva maneuver, mitral inflow, and tissue Doppler parameters, was assessed.
- Concordance was evaluated between the American Society of Echocardiography/European Association of Echocardiography (ASE/EAE) recommendations, Olmstead County, and Canberra Study protocols for grading LVDD.
Main Results:
- High feasibility (≥93%) was observed for most diastolic indices, with mitral inflow and tissue Doppler parameters exceeding 99%.
- Diastolic function remained unclassifiable in 6% to 19% of patients.
- Fair concordance was found between ASE/EAE and Olmstead County (κ=0.25) and Canberra (κ=0.27) protocols, with significant reclassification rates (51% and 43.7%, respectively). Good concordance was noted between Olmstead County and Canberra (κ=0.68).
Conclusions:
- Doppler echocardiography for LV diastolic function assessment is highly feasible in primary care settings.
- While grading LVDD is possible, substantial discrepancies exist among different established criteria, leading to poor concordance in data interpretation.
- These concordance issues may affect patient stratification and clinical management decisions in primary care.
Abstract:
The presence of left ventricular (LV) diastolic dysfunction (DD) as characterized by Doppler echocardiography is associated with worse overall mortality both in symptomatic and asymptomatic patients. However, available data on this topic come from referral centers and have been obtained by different, validated algorithms for each single study. Thus, we aimed at determining the feasibility of comprehensive evaluation of LVDD in a primary care outpatient setting and at testing the concordance of different methodological approaches in grading diastolic dysfunction. Eight hundred eighty-five consecutive outpatients, in sinus rhythm, prospectively underwent Doppler echocardiography according to a predetermined protocol. Feasibility of each LV diastolic index and concordance between 3 methods to determine the degree of LVDD, namely the American Society of Echocardiography/European Association of Echocardiography (ASE/EAE) recommendations, the Olmstead County, and the Canberra Study protocols, were tested. Feasibility of all diastolic indexes was high, ranging from 93% of Valsalva maneuver to ≥99% for mitral inflow and tissue Doppler parameters. Diastolic function was not classifiable in 6% to 19% of patients. The concordance for LV diastolic dysfunction degree was fair when comparing the classification of the ASE/EAE with those from Olmstead County (κ = 0.25; reclassification rate 51%) and Canberra Study (κ = 0.27; reclassification rate 43.7%), and was good for the comparison between the Olmstead County and Canberra classifications (κ = 0.68, reclassification rate 27%). In conclusion, feasibility of LV diastolic function measurements is very high and grading diastolic dysfunction is possible in most patients in primary care settings. Substantial differences, however, exist when concordance is tested among 3 documented criteria, resulting in poor concordance of data interpretation and hence patient stratification and clinical management.
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