Abstract 20631: Mechanistic Validation of the 2016 American Society of Echocardiography Guidelines for Assessment of Diastolic Dysfunction
Introduction: The American Society for Echocardiography 2016 guidelines for assessment of diastolic dysfunction (DD) are based on a phenomenological rather than direct mechanistic assessment. The Parameterized Diastolic Filling (PDF) formalism is a validated theoretical framework whereby the mechanics of left ventricular (LV) filling are measured mathematically by describing the shape of the E-wave using the laws of physics that govern the recoil of a spring.
Hypothesis: PDF analysis can provide mechanistic insight into the mechanical properties governing DD in patients with reduced LV ejection fraction (EF).
Methods: Patients referred for echocardiography with reduced LV EF (<45%) were prospectively classified into DD grade according to 2016 guidelines. Serial E-waves acquired during free breathing were analyzed using in-house developed image analysis software employing the PDF formalism to measure the mechanical properties of LV filling.
Results: Patients were classified as DD grade 1 (n=30) or grade 2-3 (n=20) (overall mean±SD age 64±14 years, 62% male, heart rate 73±14 beats/min, no differences between groups). Higher DD grade was associated with increased chamber stiffness (261±71 g/s2 vs 169±61 g/s2, p<0.001), increased filling energy (2.0±0.9 mJ vs 1.0±0.5 mJ, p<0.001) and greater peak forces resisting filling (median [interquartile range], 18 [15-24] mN vs 11 [8-14] mN, p<0.001). DD grade was unrelated to chamber viscoelasticity (21±4 g/s vs 20±6 g/s, p=0.32).
Conclusions: Higher grade DD was associated with an increase in mechanical properties that determine the physics of poorer left ventricular filling. These findings provide mechanistic insight into, and independent validation of the appropriateness of the 2016 guidelines for assessment of DD in patients with reduced EF.
- Diastolic function
- Noninvasive cardiac imaging
- Heart failure
- Myocardial torsion and recoil
Author Disclosures: Y.H. Goldberg: None. D. Megyessi: None. M. Flam: None. D.M. Spevack: None. M. Sundqvist: None. M. Ugander: None.
- © 2016 by American Heart Association, Inc.