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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.
Background:
Doppler-based diastolic dysfunction assessment requires optimal apical views and specialized expertise, and up to 30% of evaluations yield indeterminate results. We investigated whether a parasternal long-axis (PLAX)-only M-mode scoring system derived from mitral valve anterior leaflet (MVAL) motion could provide clinically useful risk stratification for moderate-to-severe left ventricular diastolic dysfunction (LVDD).
Methods:
This retrospective study analyzed echocardiographic data from 253 patients. Novel M-mode parameters (EPSS, APSS, EPOL, APOL, and their ratios) were compared with conventional Doppler indices across LVDD severity grades (normal, grade 1, grade 2, grade 3). A logistic regression-based scoring system combining five M-mode parameters was developed and internally evaluated using five-fold cross-validation with bootstrap confidence intervals.
Results:
The EPOL/APOL ratio showed moderate correlations with the E/A ratio in both normal-to-mild (r = 0.353, p < 0.001) and moderate-to-severe (r = 0.397, p = 0.001) LVDD groups. The logistic regression-derived scoring system achieved an AUC of 0.754 (95% CI: 0.672-0.825), with 55.7% sensitivity and 85.9% specificity at the optimal cutoff of 63.5. Decision curve analysis demonstrated positive net benefit over default strategies across the clinically plausible threshold probability range of 0.15-0.35.
Conclusion:
A PLAX-only M-mode scoring system provides acceptable discrimination and positive net clinical benefit for risk stratification of moderate-to-severe LVDD. External validation in independent populations is required before clinical implementation.
Insights
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.
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.
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