The prevalence of left ventricular diastolic filling abnormalities in patients with suspected heart failure
A P Davie1, C M Francis, L Caruana
1University of Glasgow, UK.
Insights
Left ventricular diastolic dysfunction is less common than previously thought, with the E/A ratio proving unreliable for detecting these abnormalities in heart failure patients.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- One-third of heart failure patients exhibit normal left ventricular systolic function.
- Diastolic dysfunction is often present in these patients but its prevalence is unclear.
- Previous studies focused on small, highly selected patient groups.
Purpose of the Study:
- To determine the prevalence of left ventricular diastolic filling abnormalities.
- To assess these abnormalities in a large, unselected heart failure cohort.
- To evaluate the utility of the E/A ratio in diagnosing diastolic dysfunction.
Main Methods:
- Utilized echocardiography with Doppler assessment of transmitral flow.
- Calculated the E/A ratio for 371 patients with normal systolic function.
- Compared E/A ratios against age-adjusted reference ranges.
Main Results:
- Among 534 referred patients, 371 had normal systolic function and a measurable E/A ratio.
- Only 9 patients had E/A ratios above the reference range and 19 below.
- This indicates a low prevalence of diastolic abnormalities, with only 10 more cases than expected in a normal population.
Conclusions:
- Left ventricular diastolic filling abnormalities appear less common than previously assumed.
- The E/A ratio may be of limited use in detecting these abnormalities.
- Further research is needed to validate diagnostic methods for diastolic dysfunction.
Aims:
It is reported that one third of patients with heart failure have normal left ventricular systolic function, and may or may not have left ventricular diastolic dysfunction. We sought to define the prevalence of left ventricular diastolic filling abnormalities in a large unselected group of patients, unlike the diagnosis by exclusion in the small highly selected groups of patients studied previously.
Methods And Results:
Patients were referred by general practitioners to an open-access echocardiography service for assessment of possible heart failure. Echocardiography included a Doppler study of transmitral flow at the tips of the mitral leaflets and calculation of an E/A ratio. Of 534 patients referred and assessed, 371 patients had normal systolic function and a measurable E/A ratio. These were compared with age-adjusted reference ranges to give 9 above the reference range and 19 below. This is only 10 more than would be expected if our patients were normal. In the same group of patients we found 96 cases of left ventricular systolic dysfunction, or 52 amongst the 423 with a measurable E/A ratio.
Conclusion:
Either left ventricular diastolic filling abnormalities are very much less common than previously supposed or the E/A ratio is almost useless for their detection.
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