Abstract 576: Can Doppler Echocardiography Define Diastolic Heart Failure?
Objectives: Almost half of the patients presenting with heart failure (HF) have normal systoic function and are diagnosed with diastolic HF. Three echo Doppler variables utilized to diagnose diastolic dysfunction are transmitral pulsed Doppler E/A, tissue Doppler (DTI) e′/a′ and E/e′ ratio. Progressive age-related abnormalities in these diastolic parameters may impact their ability to discriminate between age related diastolic abnormalities and diastolic HF. The purpose of this study was to determine the prevalence of diastolic abnormalities defined by these echo variables in a large cohort of pts.
Methods: We included pts having a transthoracic echo from January 2008 to April 2009 in sinus rhythm, with EF > 45%, and with both E/A and DTI e’/a’ measured. Echo parameters were abnormal if E/A and/or DTI e’/a’ were ≤1 and E/e’ ≥ 15. Pts were divided by age by decade for analysis.
Results: Of the 13,491 pts, 9,535 met inclusion criteria. Results by decade (figure⇓) demonstrated that by age 40 – 49 yrs ≥ 60% of pts had ≥ 1 abnormal diastolic parameter and by 60 – 69 yrs ≥ 90% had ≥ 1 abnormal diastolic parameter. E/A and DTI e’/a’ showed a similar trend with age, with ≥ 50% of pts having a ratio ≤1 by age 50 –59. E/e’ ratio was not as age dependent as E/A or DTI e’/a’; only 52% were abnormal by age 90–99.
Conclusion: Current Doppler determinants of diastolic dysfunction demonstrate age dependent changes and may fail to provide adequate discrimination as a HF diagnostic tool. Because E/A and DTI e’/a’ change with aging, they may not differentiate natural from pathologic abnormalities. However, E/e’ ≥ 15 which develops more gradually with aging may provide a better indicator of diastolic dysfunction.