Abstract 15535: Reclassification and Hemodynamic Correlations of Patients With Diastolic Dysfunction Based on Updated Left Ventricular Diastolic Dysfunction Guidelines
Background: An updated 2016 echocardiographic algorithm for diagnosing left ventricular (LV) diastolic dysfunction (DD) was recently proposed. We aimed to compare the hemodynamic correlations of new echocardiographic LVDD grading algorithm to the 2009 version.
Methods: We retrospectively studied patients free of atrial fibrillation or significant mitral valve disease who underwent transthoracic echocardiography while in normal sinus rhythm within 24 hours of elective heart catheterization between January 2008 and October 2010. Left ventricular end-diastolic pressure (LVEDP), the time constant of isovolumic pressure decay (Tau), and end-diastolic volume index at a pressure of 20mmHg (EDVi20) were determined.
Results: A total of 460 patients were identified (mean age 63 ± 13years; 61% male; mean LVEF 55 ± 13%, 28% with LVEDP ≥20 mmHg).The 2009 LVDD Guidelines classified 55 patients (12%) as normal diastolic function, 132 (29%) as grade 1, 156 (34%) as grade 2, and 117 (25%) as grade 3 DD. Based on 2016 Guidelines, 175 patients (38%) were normal, 110 (24%) patients were grade 1, 69 (15%) were grade 2, and 25 (5%) were grade 3 DD, and the rest were indeterminate. The 2016 Guidelines had superior discriminatory accuracy in predicting LVEDP, EDVi20 and brain natriuretic peptide levels (BNP) (p< 0.001 for all), but were not superior in predicting Tau with significant overlap between DD grades (Figure). In a stepwise multiple linear regression analysis, of all the parameters proposed in the 2016 Guidelines, E/e’ and left atrial volume index were the only ones that were independently associated with elevated LVEDP (multiple r = 0.36, R2 = 0.13, p < 0.001).
Conclusions: The grading algorithm proposed by 2016 LVDD Guidelines predicted LVEDP, EDVi20, and BNP better than the 2009 Guidelines. Even with the new algorithm, the overlap between DD grades highlight the need for further refinement.
Author Disclosures: K. Sato: None. A.D. Grant: None. K. Negishi: None. T. Negishi: None. A. Kumar: None. P. Cremer: None. P. Collier: None. S.R. Kapadia: None. R.A. Grimm: None. M.Y. Desai: None. B.P. Griffin: None. Z.B. Popovic: None.
- © 2016 by American Heart Association, Inc.