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Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a

Arno A van de Bovenkamp1, Vidya Enait1, Frances S de Man2

  • 1Department of Cardiology Amsterdam Cardiovascular Sciences (ACS) Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands.

Journal of the American Heart Association
|September 3, 2021
PubMed

Insights

The 2016 ASE/EACVI echocardiography algorithm shows limited accuracy for diagnosing diastolic dysfunction in heart failure patients. Its sensitivity was particularly low, making it unreliable for this patient group.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Heart Failure Research

Background:

  • Echocardiography is crucial for diagnosing heart failure with preserved ejection fraction (HFpEF).
  • Validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) algorithm for diastolic dysfunction assessment in HFpEF is limited.
  • Unexplained dyspnea and pulmonary hypertension are common clinical presentations requiring accurate diastolic function evaluation.

Purpose of the Study:

  • To assess the diagnostic performance of the 2016 ASE/EACVI echocardiography algorithm.
  • To compare the algorithm's accuracy against invasive measurements (pulmonary capillary wedge pressure) and other diagnostic tools (H2FPEF score, NT-proBNP).
  • To evaluate the algorithm's utility in patients with unexplained dyspnea or pulmonary hypertension.

Main Methods:

  • A study involving 204 patients evaluated for dyspnea or pulmonary hypertension using echocardiography and right heart catheterization.
  • Pulmonary capillary wedge pressure (PCWP) served as the gold standard for invasive assessment.
  • Diagnostic performance metrics including correlation, sensitivity, specificity, accuracy, and area under the curve were calculated for the ASE/EACVI algorithm, H2FPEF score, and NT-proBNP.

Main Results:

  • The 2016 ASE/EACVI algorithm demonstrated poor correlation with PCWP for key echocardiographic parameters (indexed left atrial volume, E/e', E, e', tricuspid regurgitation).
  • The algorithm's overall accuracy was 67% with low sensitivity (35%) and an area under the curve of 0.56.
  • In 30% of cases, the algorithm was indeterminate or not applicable. The H2FPEF score showed better accuracy (73%) than NT-proBNP (57%).

Conclusions:

  • The 2016 ASE/EACVI algorithm has limited diagnostic accuracy for diastolic function in patients with unexplained dyspnea and/or pulmonary hypertension.
  • The algorithm's low sensitivity is a significant limitation for detecting diastolic dysfunction.
  • Alternative or complementary diagnostic approaches may be necessary for accurate HFpEF diagnosis in this population.

Keywords:
diagnosticsechocardiographyheart failure with preserved ejection fractionright heart catheterization

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