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Reliability of updated left ventricular diastolic function recommendations in predicting elevated left ventricular filling pressure and prognosis

Citation

Sato, K and Grant, ADM and Negishi, K and Cremer, PC and Negishi, T and Kumar, A and Collier, P and Kapadia, SR and Grimm, RA and Desai, MY and Griffin, BP and Popovic, ZB, Reliability of updated left ventricular diastolic function recommendations in predicting elevated left ventricular filling pressure and prognosis, American Heart Journal, 189 pp. 28-39. ISSN 0002-8703 (2017) [Refereed Article]

Copyright Statement

Copyright 2017 Elsevier Inc.

DOI: doi:10.1016/j.ahj.2017.03.022

Abstract

Background: An updated 2016 echocardiographic algorithm for diagnosing left ventricular (LV) diastolic dysfunction (DD) was recently proposed. We aimed to assess the reliability of the 2016 echocardiographic LVDD grading algorithm in predicting elevated LV filling pressure and clinical outcomes compared to the 2009 version.

Methods: We retrospectively identified 460 consecutive patients without atrial fibrillation or significant mitral valve disease who underwent transthoracic echocardiography within 24 hours of elective heart catheterization. LV end-diastolic pressure (LVEDP) and the time constant of isovolumic pressure decay (Tau) were determined. The association between DD grading by 2009 LVDD Recommendations and 2016 Recommendations with hemodynamic parameters and all-cause mortality were compared.

Results: The 2009 LVDD Recommendations classified 55 patients (12%) as having normal, 132 (29%) as grade 1, 156 (34%) as grade 2, and 117 (25%) as grade 3 DD. Based on 2016 Recommendations, 177 patients (38%) were normal, 50 (11%) were indeterminate, 124 (27%) patients were grade 1, 75 (16%) were grade 2, 26 (6%) were grade 3 DD, and 8 (2%) were cannot determine. The 2016 Recommendations had superior discriminatory accuracy in predicting LVEDP (P < 0.001) but were not superior in predicting Tau. During median follow-up of 416 days (interquartile range: 5 to 2004 days), 54 patients (12%) died. Significant DD by 2016 Recommendations was associated with higher risk of mortality (P = 0.039, subdistribution HR1.85 [95% CI, 1.03-3.33]) in multivariable competing risk regression.

Conclusions: The grading algorithm proposed by the 2016 LV diastolic dysfunction Recommendations detects elevated LVEDP and poor prognosis better than the 2009 Recommendations.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Negishi, K (Dr Kazuaki Negishi)
Author:Negishi, T (Dr Tomoko Negishi)
ID Code:116525
Year Published:2017
Deposited By:Menzies Institute for Medical Research
Deposited On:2017-05-11
Last Modified:2017-12-14
Downloads:0

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