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Published on: December 13, 2019
[The Evaluation of Left Ventricular Diastolic Function by Echocardiography in Patients With Preserved Ejection
M N Alekhin1,2, A M Grishin1,2, O A Petrova1,2
1Central Clinical Hospital with Polyclinic President Management Department RF, Moscow, Russia.
Objective:
to compare non-invasive evaluation of left ventricular (LV) diastolic function (DF) by echocardiography using algorithms of the 2009 and 2016 American Society of Echocardiography (ASE)/European Association of Echocardiography (EAE, now European Association of Cardiovascular Imaging [EACVI]) Recommendations.
Material And Methods:
The study included 100 patients with sinus rhythm and preserved left ventricular (LV) ejection fraction (EF). In all patients LV DF was assessed using both algorithms. In accordance with the ASE/EAE 2009 algorithm pulsed-wave tissue Doppler early diastolic velocity (e velocity) at lateral and septal basal regions of mitral annulus, as well as left atrial maximum volume index were evaluated. In accordance with the ASE/EACVI 2016 algorithm for judging the presence of LV diastolic dysfunction (DD), in addition to the two above-described criteria, E/e ratio and peak velocity of tricuspid regurgitation were analyzed. In the presence of 1 and more or equal 3 criteria LVDF was classified as normal and DD, respectively. If 2 criteria were detected result was considered as indeterminate.
Results:
In 70% of patients in accordance with the ASE/EACVI 2016 algorithm DF was evaluated with 4 and in 100% - with 3 proposed criteria. The reason for using only 3 criteria was inadequate imaging of tricuspid regurgitation flow by continuous wave Doppler. Use of ASE/EACVI 2016 compared with the ASE/EAE 2009 algorithm in patients with normal LV EF led to a significant decrease of the number of patients with LV DD (13 vs. 27%, respectively; <0.05). The main reason for this redistribution was lowering of the cutoff value of annular e septal velocity from 8 (2009 algorithm) to 7 cm/sec (2016 algorithm). Frequency of indeterminate results with the use of 2016 algorithm was 2 times less than with the use of 2009 algorithm (15 vs. 36%, respectively; p<0.001).
Conclusion:
In patients with preserved LVEF the use of ASE/EACVI 2016 algorithm led to redistribution of data of evaluation of LVDF by echocardiography towards reduction of the number of patients with LV DD and with indeterminate results.
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