Abstract 2847: High Prevalence of ’Unclassifiable’ Diastolic Dysfunction Using Current Criteria
Background: Cross sectional studies have shown that diastolic dysfunction is prevalent and impacts mortality. Classification of diastolic function (DF) requires several Doppler variables. However, in clinical practice, pts may not necessarily have concordant data, leading to confusion about classification. The issue is compounded in hospitalized patients, who are tachycardic and may have limited Doppler data.
Objective: The aims of this study were (1) to determine the percentage of pts with measurable DF data, and (2) to determine the percentage of pts with concordant data.
Methods: Data from 100 consecutive in- and outpts in sinus rhythm, compiled by a single experienced sonographer were reviewed; transmitral (E/A), deceleration time (DT), pulmonary vein flow - S/D ratio and A reversal duration (PV A dur), and tissue Doppler E’ were attempted in all. DF was classified as normal, or mild, moderate or restrictive dysfunction, based on the validated and widely used scheme of Redfield et al (JAMA 2003). E/A was used as the primary classification variable.
Results: E/A, DT and E/E’ were measurable in 3/4 of pts while PV S/D and A dur were measurable in 1/2 and 1/4 of pts, respectively. The most common reason for inability to record E/A was tachycardia (E/A fusion). Of pts with measurable data, only 55% had ≥3 concordant variables and most of those had normal DF.
Summary/Conclusions: Applying the validated DF classification scheme to a wider variety of pts demonstrates: (1) 30% pts could not be classified and (2) only 55% pts have ≥3 concordant measurements. These data suggest the need for a weighted classification scheme which, perhaps, incorporates LA and LV structure, and PA pressure.