Evolution of diastolic function algorithms: Implications for clinical practice
Matthew F Gottbrecht1,2, Michael Salerno2,3,4, Gerard P Aurigemma1
1Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Insights
Echocardiographic assessment of diastolic function is unreliable in about half of patients. Even when feasible, current guidelines provide conflicting results, impacting clinical decisions.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Diastolic function (DF) grading relies on various echocardiographic algorithms.
- Established guidelines include the Mayo Clinic scheme (2003) and American Society of Echocardiography (ASE) documents (2009, 2016).
Purpose of the Study:
- To evaluate the frequency of patient classification by three echocardiographic diastolic function algorithms.
- To assess the agreement between these different classification algorithms.
Main Methods:
- Retrospective analysis of 200 echocardiograms.
- Diastolic function assessed using Mayo 2003, ASE 2009, and ASE 2016 algorithms.
- Concordance analyzed using Kappa statistic, considering coexisting conditions like mitral annular calcification.
Main Results:
- 58.5% of studies were excluded due to coexisting conditions, poor image quality, or incomplete data.
- Only 40% agreement (Kappa=0.20) between Mayo 2003 and ASE 2016.
- 43% agreement (Kappa=0.25) between ASE 2009 and ASE 2016.
Conclusions:
- Current echocardiographic guidelines for diastolic function assessment are unreliable in nearly 50% of patients.
- Existing guidelines produce discordant results when studies are suitable for analysis.
Objective:
We undertook this study of echocardiographic classification of diastolic function by three different algorithms to determine: (1) how frequently each algorithm classified patients and (2) how well the results agreed with one another.
Background:
Several algorithms exist to grade diastolic function (DF), the Mayo Clinic scheme of Redfield et al (Mayo 2003) and the 2 ASE guideline documents of 2009 and 2016 (ASE 2009 and ASE 2016).
Methods:
A total of 200 consecutive echocardiograms were retrospectively analyzed; mean age of patients 60.3 ± 3.5 years, 45% male. Echocardiograms were performed using Intersocietal Accreditation Commission guidelines. Diastolic function was assessed by Mayo 2003 and ASE 2009 and 2016. Coexisting conditions affecting DF analysis, such as mitral annular calcification (MAC), were tabulated. Data were compared using a paired t-test. Concordance between algorithms was assessed using the Kappa statistic.
Results:
A total of 117 of 200 studies (58.5%) were excluded for the presence of coexisting conditions (51.5%), poor image quality (2.5%), or incomplete data (4.5%). Thirty-three of the remaining 83 studies (40%) received the same grade of DF based on assessments made using the Mayo 2003 and ASE 2016 algorithms; the Kappa statistic was 0.20. 36 of the 83 studies (43%) received the same grade of DF based on assessments made using the ASE 2009 and ASE 2016 algorithms; the Kappa statistic was 0.25.
Conclusion:
Assessment of diastolic function via echocardiography cannot be reliably accomplished in approximately 50% of patients using current guidelines. Further, when studies are suitable for assessment, widely used guidelines yield discordant results.
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