scholarly journals 560 The inclusion of pulmonary arterial pressure misclassifies diastolic function using the current EACVI guidelines in pre-capillary pulmonary hypertension

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Telmisani ◽  
J Deschamps ◽  
A Alturki ◽  
B Fox ◽  
I A Sebag ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Diastolic Function ◽  
Left Atrial Volume ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Diagnostic Reliability ◽  
Left Heart Catheterization ◽  
Pulmonary Arterial ◽  
Grade 3

Abstract Background Pulmonary hypertension (PH) can be pre-capillary or post-capillary (PVH) etiology based on left-sided filling pressures and pulmonary vascular resistance. The 2016 EACVI/ASE Recommendations for the Evaluation of Left Ventricular Diastolic Function (LVDF) provides flow-diagrams to categorize patients. Parameters used include left atrial volume, Doppler-derived transmitral and mitral annular velocities, and systolic PA pressure (sPAP). There are no dedicated criteria to assess the diastolic function in pulmonary arterial hypertension (PAH). Additionally, diseases such as scleroderma can result in both PAH and PVH, thus including sPAP may alter LVDF diagnostic reliability in this population. Purpose Because elevated PAP is fundamental to PAH, we hypothesized that the EACVI/ASE diastolic function algorithm has a lower predictive value in correctly classifying diastolic function in scleroderma. Methodology We performed a single-center retrospective analysis of scleroderma patients who underwent complete echocardiography and comprehensive right and left heart catheterization for PH evaluation. PH categorization was defined using the 6th World Symposium hemodynamic definitions (PAH as mPAP ≥20 mmHg, PCWP ≤15 mmHg, PVR ≥ 3 WU). Diastolic function categorization used 2016 EACVI/ASE recommendations. Index catheterization and echocardiogram closest to cardiac catheterization were analyzed. Results 260 patients underwent evaluation and 63 were diagnosed with PH. PAH was diagnosed in 35 (age 64 ±10, mPAP 55± 18 mmHg, LVEF 60 ± 6%) and PVH in 28 (age 65 ± 10, mPAP 34 ± 14 mmHg, LVEF 63 ± 6%). Of the PAH patients, 20 had normal LVEDP (≤ 12 mmHg) and 15 increased LVEDP. In the PAH normal LVEDP patients, the EACVI algorithm classified diastolic function as normal in 25%, grade 2 in 5%, Grade 3 in 5%, and "indeterminate" in 65%. In the PAH group with increased LVEDP (> 12 mmHg), 27% were incorrectly identified as normal, 7% as grade 2 dysfunction, and 66% as indeterminate. The diastolic function algorithm has a sensitivity of 27% and specificity of 75% to diagnose a LVEDP ≤ 12 mmHg, with an AUC of 0.508 (p = 0.91). With exclusion of sPAP from the algorithm, indeterminate cases in both PAH groups were reclassified as normal, resulting in improved sensitivity (93%) but poorer specificity (10%), and a similar AUC (0.517, p = 0.72). In PVH patients, the algorithm performed better with a sensitivity of 63% and specificity of 83% to predict LVEDP > 12 mmHg with AUC 0.773, p = 0.017. Conclusion In scleroderma patients with PAH, the EACVI diastolic algorithm performs poorly and is confounded by including PAP as a parameter. The sensitivity of the algorithm is improved by the exclusion of sPAP although with reduced specificity. It remains inadequate to reliably diagnose normal LVEDP. While useful in other populations, algorithm modifications including exclusion of PAP, must be employed in suspected scleroderma PAH.

scholarly journals DIASTOLIC DYSFUNCTION – NEGATIVE PROGNOSTIC FACTOR IN PATIENTS WITH HEPATIC CIRRHOSIS

2017 ◽  
Vol 64 (2) ◽  
pp. 110-116
Author(s):  
Alexandru Mihailovici ◽  
◽  
Maria Buşe ◽  
Ionuţ Donoiu ◽  
Octavian Istrătoaie ◽  
...  
Keyword(s):  
Liver Disease ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Color Doppler ◽  
Left Atrial Volume ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Negative Prognostic Factor ◽  
Dimensional Echocardiography ◽  
Grade 3

Objectives. To evaluate the left ventricular diastolic function in patients with cirrhosis and to establish its relation to the degree of severity of liver disease as well as to biological markers of cardiac dysfunction. Methods. We included 72 patients diagnosed with liver cirrhosis in different degrees of disease progression. Cardiac parameters were evaluated by two-dimensional echocardiography and color Doppler. Results. In terms of diastolic echocardiographic function, 26 patients had normal diastolic function, 36 had grade 1 diastolic dysfunction, 8 had grade 2 dysfunction, and 2 patients had grade 3. Diastolic dysfunction was unrelated to age, gender and etiology of cirrhosis. Of all the echocardiographic parameters, left ventricular hypertrophy, right cavity dimensions, E wave deceleration time, left atrial volume were significantly higher in patients with diastolic dysfunction, correlated with the severity of cirrhosis. Significantly elevated NT-proBNP and TnI were seen among the patients with diastolic dysfunction. Conclusions. The present study shows that although diastolic dysfunction is common in cirrhosis, it is usually incipient and most often correlates with the severity of the liver disease (Child-Pugh class).

P14893D strain echocardiography in assessing left ventricular diastolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H T Ozer ◽  
O Ozer ◽  
C Coteli ◽  
A Kivrak ◽  
M L Sahiner ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Heart Catheterization ◽  
Left Heart ◽  
Left Heart Catheterization ◽  
2D Strain

Abstract Background Diastolic dysfunction is an important factor in the development of heart failure with preserved ejection fraction (HFpEF). As the ejection fraction is preserved in HFpEF, the diagnosis of this disease with non-invasive methods is difficult. Purpose In this study, the relationship of BNP, NT-proBNP, Ghrelin, and echocardiographic 3D strain findings with diastolic dysfunction was investigated in patients undergoing left heart catheterization. Methods Our study is a cross-sectional study and included 78 patients in whom echocardiography was performed, and who underwent left heart catheterization based on relevant indications. The patient data recorded for evaluation included the findings from left heart catheterization, follow-up 3D echocardiography; and the levels of blood NT-proBNP, and Ghrelin. Results The rate of diastolic dysfunction was 42.3%. Longitudinal 2D and 3D mean strain as absolute values were observed to decrease more in patients with diastolic dysfunction. The median levels of BNP, NT-proBNP, and Ghrelin levels were higher in patients with diastolic dysfunction. The independent predictors of diastolic dysfunction were determined to be the left atrial volume index (LAVI) (OR=1.17; p=0.018), longitudinal 3D strain values (OR=1.88; p<0.001), NT-proBNP (OR=1.11; p=0.001), and Ghrelin (OR=1.40; p=0.001), respectively. Relationship Between LV EDP and LV Longitudinal Strain LV EDP 2D Strain 3D Strain r p r p r p BNP, pg/ml 0.429 <0.001* 0.115 0.316 0.178 0.118 NT-proBNP, pg/ml 0.484 <0.001* 0.155 0.177 0.186 0.104 Ghrelin, pg/ml 0.478 <0.001* 0.086 0.455 0.157 0.169 SolV DB – – 0.481 <0.001* 0.591 <0.001* dP/dT −0.389 <0.001* −0.283 0.012* −0.307 0.006* Negative dP/dT −0.747 <0.001* −0.337 0.003* −0.458 <0.001* 2D. % 0.481 <0.001* – – 0.852 <0.001* 3D. % 0.591 <0.001* 0.852 <0.001* – – If p value is less than 0.05 shows statistical significance. Measurement of longitudinal strain Conclusion In conclusion, our study found out that the reduced 3D strain absolute values and increased levels of NT-proBNP and Ghrelin biomarkers predicted diastolic dysfunction. If further large-scale studies prove the efficiency of these practical, they may not only allow for making a diagnosis of HFpEF more readily but may also eliminate the confusion in diagnostic algorithms. Acknowledgement/Funding None

scholarly journals Validation of evaluating left ventricular diastolic function with estimated left atrial volume from anteroposterior diameter

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yonghuai Wang ◽  
Liang Zhang ◽  
Shuang Liu ◽  
Guangyuan Li ◽  
Fanxin Kong ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Left Atrial ◽  
Large Scale ◽  
Left Atrial Volume ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Summation Method ◽  
Anteroposterior Diameter ◽  
Validation Set ◽  
Lv Diastolic Function

Abstract Background Left atrial (LA) volume (LAV) is one of the recommended key variables for evaluating left ventricular (LV) diastolic function. However, only LA anteroposterior diameter (LAAP) is available in numerous large-scale existing databases. Therefore, this study aimed to validate whether LV diastolic function could be evaluated with estimated LAV from LAAP. Methods A total of 552 inpatients with sinus rhythm were consecutively enrolled. LAV was measured by biplane Simpson’s disk summation method. LV diastolic function was evaluated according to the 2016 proposed recommendations. Best-fitting regression models of LAAP index (LAAPI)–LAV index (LAVI) were developed and equations with the highest F-value were chosen in the first 276 subjects (derivation set), and concordance for evaluating LV diastolic function between using estimated and observed LAVI was verified in the remaining 276 subjects (validation set). Results In the derivation set, the linear model has the highest F-value in all subjects and in the subjects with normal or depressed LV ejection fraction. In the validation set, using the linear equation (LAVI = 2.05 × LAAPI − 13.86), the higher area under curve and narrower range of difference were shown between estimated LAVI and observed LAVI, respectively. Further, concordance for diagnosis (overall proportion of agreement, 88.4%; κ = 0.79) and grading (overall proportion of agreement, 84.8%; κ = 0.74) of LV diastolic dysfunction was substantial between using estimated and observed LAVI. Conclusions LV diastolic function can be evaluated with estimated LAVI from LAAPI, which might provide a surrogate method when the direct measurement of LAV is not available.

scholarly journals Measures of Left Ventricular Diastolic Function and Cardiorespiratory Fitness According to Glucose Metabolism Status: The Maastricht Study

2021 ◽  
Author(s):  
Marja G. J. Veugen ◽  
Pauline B. C. Linssen ◽  
Ronald M. A. Henry ◽  
Annemarie Koster ◽  
Abraham A. Kroon ◽  
...  
Keyword(s):  
Glucose Metabolism ◽  
Diastolic Function ◽  
Left Atrial ◽  
Left Ventricular Mass Index ◽  
Left Atrial Volume ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Left Atrial Volume Index ◽  
Ventricular Diastolic Function ◽  
Normal Glucose

Background This cross‐sectional study evaluated associations between structural and functional measures of left ventricular diastolic function and cardiorespiratory fitness (CRF) in a well‐characterized population‐based cohort stratified according to glucose metabolism status. Methods and Results Six hundred seventy‐two participants from The Maastricht Study (mean±SD age, 61±9 years; 17.4% prediabetes and 25.4% type 2 diabetes mellitus) underwent both echocardiography to determine left atrial volume index, left ventricular mass index, maximum tricuspid flow regurgitation, average e′ and E/e′ ratio; and submaximal cycle ergometer test to determine CRF as maximum power output per kilogram body mass. Associations were examined with linear regression adjusted for cardiovascular risk and lifestyle factors, and interaction terms. After adjustment, in normal glucose metabolism but not (pre)diabetes, higher left atrial volume index (per 1 mL/m 2 ), left ventricular mass index (per 1 g/m 2.7 ), maximum tricuspid regurgitation flow (per 1 m/s) were associated with higher CRF (maximum power output per kilogram body mass; β in normal glucose metabolism 0.015 [0.008–0.023], P interaction (pre)diabetes <0.10; 0.007 [−0.001 to 0.015], P interaction type 2 diabetes mellitus <0.10; 0.129 [0.011–0.246], P interaction >0.10; for left atrial volume index, left ventricular mass index, maximum tricuspid regurgitation flow, respectively). Furthermore, after adjustment, in all individuals, higher average E/e′ ratio (per unit), but not average e′, was associated with lower CRF (normal glucose metabolism −0.044 [−0.071 to −0.016]), P interaction >0.10). Conclusions In this population‐based study, structural and functional measures of left ventricular diastolic function were independently differentially associated with CRF over the strata of glucose metabolism status. This suggests that deteriorating left ventricular diastolic function, although of small effect, may contribute to the pathophysiological process of impaired CRF in the general population. Moreover, the differential effects in these structural measures may be the consequence of cardiac structural adaptation to effectively increase CRF in normal glucose metabolism, which is absent in (pre)diabetes.

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