Abstract 14624: Are All Diastolic Parameters Equal?
Are All Diastolic Parameters Equal? Background: Recent guidelines propose that diastolic dysfunction may be diagnosed in pts with normal EF if >2 of 4 parameters (average E/e’, annular velocities, TR V max and LAV index) are abnormal. This suggests all diagnostic markers have equivalent diagnostic significance. We hypothesized that markers of chronically elevated LVEDP (LAV, E/e’) would be more specific than TR or e’.
Methods: We studied 243 pts undergoing investigation of dyspnea, in whom right heart catheterization was performed in close succession to an echo showing EF >50%. PCWP≥15 mmHg was used as a cut off. Pts were 62±14 yrs (75% female) with mPAP 35±13 mmHg & PCWP 13±5 mmHg. Echocardiographic parameters used were; e’ septal <7 cm/s, e’ lat <10 cm/s, TR Vmax >2.8 cm/s, LAVi > 34 ml/m2. Bivariate logistic and ROC analysis was used to determine predictive ability of echocardiographic variables. 5 groups were created to show the predictive ability when separate diastolic markers were combined; 1) those with all positive diastolic markers; 2) e’ + TR Vmax+ LAVi; 3)E/e’ + e’ + LAVi; 4)E/e’+ e’ +TR; 5)e’ + TR + LAV.
Results: Of 188 pts, 76 (40%) had elevated PCWP. Echo was nondiagnostic (2 abnormal) in 122 (35%). The variables showed high specificity and low sensitivity (Table 1). Bivariate logistic regression showed LAV (OR 2.78(1.47;5.3), p=0.002) and E/e’ (OR 6.3(2.1;18.7), p<0.001), but not e’ and TR to be associated with PCWP>15 mmHg. ROC showed that LAV (AUC 0.71) and E/e’ (AUC 0.67) to have modest discriminative power for determining PWCP. Combined groups showed that even with all 4 parameters positive (OR 6.8 (1.8;25.6, p=0.005), sensitivity was low for accurately predicting PCWP> 15 mmHg.
Conclusion: Assessment of evidence regarding prediction of PCWP>15 is discordant with opinions expressed in the guidelines.
Author Disclosures: L. Wright: None. N. Dwyer: None. S. Wahi: None. T. Marwick: None.
- © 2016 by American Heart Association, Inc.