Evaluation of left ventricular diastolic function profile in patients with pulmonary hypertension due to heart failure with preserved ejection fraction

Background Echocardiography is considered the cornerstone of the diagnostic workup of heart failure with preserved ejection fraction. Thus far, validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) echo‐algorithm for evaluation of diastolic (dys)function in a patient suspected of heart failure with preserved ejection fraction has been limited. Methods and Results The diagnostic performance of the 2016 ASE/EACVI algorithm was assessed in 204 patients evaluated for unexplained dyspnea or pulmonary hypertension with echocardiogram and right heart catheterization. Invasively measured pulmonary capillary wedge pressure (PCWP) was used as the gold standard. In addition, the diagnostic performance of H 2 FPEF score and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) were evaluated. There was a poor correlation between indexed left atrial volume, E/e′ (septal and average) or early mitral inflow (E), and PCWP ( r =0.25–0.30, P values all <0.01). No correlation was found in our cohort between e′ (septal or lateral) or tricuspid valve regurgitation and PCWP. The correlation between diastolic function grades of the ASE/EACVI algorithm and PCWP was poor ( r =0.17, P <0.05). The ASE/EACVI algorithm had a sensitivity and specificity of 35% and 87%, respectively; an accuracy of 67% and an area under the curve of 0.56. Moreover, in 30% of cases the algorithm was not applicable or indeterminate. H 2 FPEF score had a modest correlation with PCWP ( r =0.44, P <0.0001), and accuracy was 73%; NT‐proBNP correlated weakly with PCWP ( r =0.24, P <0.001), and accuracy was 57%. Conclusions The 2016 ASE/EACVI algorithm for the assessment of diastolic function has a limited diagnostic accuracy in patients evaluated for unexplained dyspnea and/or pulmonary hypertension, and especially sensitivity to detect diastolic dysfunction was low.

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Comparative effects of nebivolol and carvedilol on left ventricular diastolic function in older heart failure patients with preserved ejection fraction: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-016-1656-y ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 3

Author(s):

Kyungil Park ◽

Tae-Ho Park

Keyword(s):

Heart Failure ◽

Randomized Controlled Trial ◽

Ejection Fraction ◽

Controlled Trial ◽

Left Ventricular Diastolic Function ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Ventricular Diastolic Function ◽

Heart Failure Patients ◽

Randomized Controlled

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Left Atrial Longitudinal Strain Evaluated by 2D Speckle Tracking Echocardiography Can Identify Patients with Heart Failure with Preserved Ejection Fraction

Internal Medicine ◽

10.2478/inmed-2019-0048 ◽

2019 ◽

Vol 16 (1) ◽

pp. 7-19

Author(s):

Mihaela Bolog ◽

Mihaela Dumitrescu ◽

Mârzan Luminiţa ◽

Florentina Romanoschi ◽

Elena Păcuraru ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Diastolic Function ◽

Left Atrial ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Signs And Symptoms ◽

Left Ventricular Diastolic Function ◽

Left Ventricular ◽

Preserved Ejection Fraction

AbstractThe aim of the paper is to investigate the utility of left atrial longitudinal strain (LALS) in the diagnosis of heart failure with preserved ejection fraction (HFpEF) when left ventricular diastolic function is indeterminable and the assessment of natriuretic peptides is not routinely performed.Method. The study included 180 patients with signs and symptoms suggestive of non-acute heart failure, examined clinically and echocardiographically, both conventionally and via speckle tracking method.Results. 33 patients had a normal echocardiographic examination. Diastolic dysfunction (DD) was present in 116 patients of whom 32 patients had grade I, 66 patients grade II, 18 patients grade III DD. Diastolic function could not be determined in 31 patients. The mean value of LALS and NTproBNP in patients with normal echocardiography was significantly different from the group with DD for both variables (p<0.001). LALS was inversely correlated with the grade of DD (r=-0.83, p<0.001). The cut-off value of LALS for predicting DD was 25%. Applying this value in patients with indeterminate diastolic function we identified 21 patients with HFpEF (p<0.001).Conclusions. LALS can help in the diagnosis of HFpEF when other echocardiographic criteria are irrelevant and NTproBNP is not routinely performed. LALS was correlated with the presence and severity ofDDwith a cut-off value of 25%.

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