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PLAX-Only M-Mode Scoring System for Risk Stratification of Moderate-to-Severe Left Ventricular Diastolic Dysfunction:

Jonghoon Yoo1, Taekwon Kim1, Kyungsub Song2

  • 1Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.

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Summary

A new M-mode scoring system using parasternal long-axis views can help risk-stratify moderate-to-severe left ventricular diastolic dysfunction (LVDD). This approach offers a simpler alternative to Doppler methods, improving diagnostic efficiency for LVDD.

Keywords:
M‐mode echocardiographyleft ventricular diastolic dysfunctionlogistic regressionmitral valvepoint‐of‐care ultrasoundrisk stratification

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Area of Science:

  • Cardiology
  • Echocardiography
  • Diastolic Dysfunction

Background:

  • Doppler-based diastolic dysfunction assessment is challenging, requiring specific views and expertise, with up to 30% indeterminate results.
  • Investigated a simplified approach using parasternal long-axis (PLAX)-only M-mode scoring for risk stratification of left ventricular diastolic dysfunction (LVDD).

Purpose of the Study:

  • To evaluate the clinical utility of a novel M-mode scoring system derived from mitral valve anterior leaflet (MVAL) motion for assessing moderate-to-severe LVDD.
  • To determine if this PLAX-only system can provide clinically useful risk stratification.

Main Methods:

  • Retrospective analysis of echocardiographic data from 253 patients.
  • Novel M-mode parameters (EPSS, APSS, EPOL, APOL, and ratios) were compared with conventional Doppler indices across LVDD grades.
  • A logistic regression-based scoring system was developed and validated using cross-validation.

Main Results:

  • The EPOL/APOL ratio correlated moderately with the E/A ratio in different LVDD groups.
  • The logistic regression scoring system achieved an AUC of 0.754, with 55.7% sensitivity and 85.9% specificity.
  • Decision curve analysis indicated a positive net clinical benefit for risk stratification.

Conclusions:

  • A PLAX-only M-mode scoring system demonstrates acceptable discrimination for moderate-to-severe LVDD risk stratification.
  • This system offers a potential alternative to complex Doppler assessments.
  • External validation is recommended prior to widespread clinical adoption.