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Grading diastolic function by echocardiography: hemodynamic validation of existing guidelines


Grant, ADM and Negishi, K and Negishi, T and Collier, P and Kapadia, SR and Thomas, JD and Marwick, TH and Griffin, BP and Popovic, ZB, Grading diastolic function by echocardiography: hemodynamic validation of existing guidelines, Cardiovascular Ultrasound, 13 Article 28. ISSN 1476-7120 (2015) [Refereed Article]


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Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

DOI: doi:10.1186/s12947-015-0023-6


Background: While echocardiographic grading of left ventricular (LV) diastolic dysfunction (DD) is used every day, the relationship between echocardiographic DD grade and hemodynamic abnormalities is uncertain.

Methods: We identified 460 consecutive patients who underwent transthoracic echocardiography within 24 h of elective left heart catheterization and had: normal sinus rhythm, no confounding structural heart disease, no change in medications between catheterization and echo, and complete echocardiographic data. Patients were grouped based on echocardiographic DD grade. Hemodynamic tracings were used to determine time constant of isovolumic pressure decay (Tau), LV end-diastolic pressure (LVEDP) and end-diastolic volume index at a pressure of 20 mmHg (EDVi20).

Results: Normal diastolic function was found in 55 (12.0%) patients, while 132 (28.7%) patients had grade 1, 156 (33.9%) grade 2 and 117 (25.4%) grade 3 DD. The median value for Tau was 46.9 ms for the overall population (interquartile range 38.6-58.1 ms), with a prevalence of a prolonged Tau (> 48 ms) of 47.5%. While there was an association between DD grade and Tau (p = 0.003), LV dysfunction (ejection fraction < 50%) was more strongly associated with increased Tau (p < 0.001) than was DD grade (p < 0.19). There was also an association between DD grade and LVEDP (p < 0.001), with both LV dysfunction (p = 0.029) and DD grade (p < 0.001) independently associated with LVEDP. Calculated EDVi20 was related to DD grade, but this relationship was driven by findings of paradoxically increased compliance in patients with severe DD.

Conclusions: Although echocardiographic grading of DD was related to invasive hemodynamics in this population, the relationship was modest.

Item Details

Item Type:Refereed Article
Keywords:diastolic function, diastolic dysfunction, left ventricular end-diastolic pressure, left ventricular filling pressure, E/A ratio, tissue doppler echocardiography
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
UTAS Author:Negishi, T (Dr Tomoko Negishi)
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:101527
Year Published:2015
Web of Science® Times Cited:24
Deposited By:Menzies Institute for Medical Research
Deposited On:2015-06-25
Last Modified:2017-11-03
Downloads:213 View Download Statistics

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