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Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms-A Primary Care
Martina Setti1, Giovanni Benfari1, Donato Mele2
1Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy.
Insights
Current diastolic function guidelines show inconsistencies. The left atrial volume index/late diastolic a'-ratio (LAVi/a') effectively resolves indeterminate diagnoses in echocardiography.
Area of Science:
- Cardiology
- Echocardiography
- Diastology
Background:
- Current guidelines for diastolic function (DF) assessment by ASE/EACVI face disputes.
- Two alternative algorithms by Johansen et al. and Oh et al. have been proposed.
- This study compares ASE/EACVI guidelines with these alternative approaches.
Purpose of the Study:
- Assess concordance between ASE/EACVI guidelines and alternative DF assessment methods.
- Evaluate the prevalence of indeterminate diastolic dysfunction (DD) using each method.
- Identify strategies to reduce indeterminate DD diagnoses.
Main Methods:
- Retrospective analysis of 1158 echocardiographic reports.
- Calculation of concordance using k coefficient and DD reclassification rate.
- Assessment of pulmonary vein flow (PVF), Valsalva maneuver, and LAVi/a' for indeterminate grading.
Main Results:
- Significant discordance observed between all compared methods (p < 0.0001).
- DD reclassification rates ranged from 30.1% to 36.5%.
- LAVi/a' proved most effective in resolving indeterminate diagnoses, followed by PVF and Valsalva maneuver.
Conclusions:
- Inconsistencies among DF assessment guidelines limit clinical interchangeability.
- Conventional echocardiography, particularly LAVi/a', can resolve most inconclusive diagnoses.
- LAVi/a' offers a simple and effective method for improving diastolic dysfunction grading.
Background:
Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number.
Methods:
We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without (n = 644) or with (n = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a'-ratio (LAVi/a') over indeterminate grading was assessed.
Results:
The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a', with the latter being the single most effective parameter.
Conclusion:
Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a' emerges as a simple and effective approach to this aim.
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