Grading diastolic function by echocardiography: hemodynamic validation of existing guidelines

Cardiovascular Ultrasound

Research

Brian P. Griffin¹  Samir R. Kapadia¹  Patrick Collier¹  Zoran B. Popović²  Andrew D. M. Grant³  Tomoko Negishi⁴  Kazuaki Negishi⁴  Thomas H. Marwick⁴  James D. Thomas⁵ 

[1] Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA;Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA;Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, 44195, Cleveland, OH, USA;Libin Cardiovascular Institute, University of Calgary, Calgary, Canada;Menzies Research Institute, University of Tasmania, Tasmania, Australia;Northwestern University Feinberg School of Medicine, Chicago, USA;

关键词: Diastolic function;    Diastolic dysfunction;    Left ventricular end-diastolic pressure;    Left ventricular filling pressure;    E/A ratio;    Tissue Doppler echocardiography;   

DOI  :  10.1186/s12947-015-0023-6

 received in 2015-03-11, accepted in 2015-06-19,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundWhile echocardiographic grading of left ventricular (LV) diastolic dysfunction (DD) is used every day, the relationship between echocardiographic DD grade and hemodynamic abnormalities is uncertain.MethodsWe 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).ResultsNormal 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.ConclusionsAlthough echocardiographic grading of DD was related to invasive hemodynamics in this population, the relationship was modest.

【 授权许可】

Unknown   
© Grant et al. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.