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Echocardiographic diagnosis of left ventricular diastolic dysfunction: Impact of coronary artery disease

Oleg F Sharifov1, John M Murphy1, Gilbert J Perry1,2

  • 1Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

Echocardiography (Mount Kisco, N.Y.)
|December 15, 2020
PubMed

Insights

The 2016 American Society of Echocardiography (ASE) guidelines for left ventricular diastolic dysfunction (LVDD) may underdiagnose early cases in patients with coronary artery disease (CAD). Adding isovolumetric relaxation time (IVRT) can improve detection of LVDD.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Echocardiography

Background:

  • The 2016 American Society of Echocardiography (ASE) guidelines for left ventricular (LV) diastolic dysfunction (DD) have limitations in detecting early hemodynamic abnormalities, particularly in subclinical coronary artery disease (CAD).
  • The accuracy of ASE categorization for early LVDD may be influenced by the presence or absence of a known CAD history.

Purpose of the Study:

  • To evaluate the impact of known coronary artery disease (CAD) history on the accuracy of the 2016 ASE algorithm for diagnosing early left ventricular diastolic dysfunction (LVDD).
  • To assess the utility of adding isovolumetric relaxation time (IVRT) to echocardiographic assessment for improving LVDD detection in patients with and without CAD.

Main Methods:

  • 34 patients with NYHA class I-II symptoms and preserved LV ejection fraction underwent echocardiography and cardiac catheterization with high-fidelity LV pressure measurement.
  • Echocardiographic images were analyzed for LVDD using the 2016 ASE algorithm, both with and without knowledge of CAD history and angiography findings.
  • Coronary artery disease (CAD) was defined by catheterization findings and considered indicative of DD for the algorithm's purpose.

Main Results:

  • Coronary artery disease (CAD) was present in 65% of patients.
  • Without considering CAD history, 29 patients were classified as DD- and only 3 as DD+.
  • Inclusion of CAD history reclassified 59% of patients to DD+ (grade I), with 95% of these showing increased isovolumetric relaxation time (IVRT).

Conclusions:

  • The 2016 ASE algorithm accurately identifies early LVDD when CAD is known but underdiagnoses grade I LVDD in its absence.
  • Incorporating echocardiographic IVRT can enhance the diagnostic discrimination of LVDD, especially when CAD status is initially unknown.
Abstract

Keywords:
2016 American Society of Echocardiography guidelinescoronary artery diseaseleft heart catheterizationleft ventricular diastolic dysfunctionleft ventricular end diastolic pressureleft ventricular relaxation

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