European Journal of Echocardiography Advance Access originally published online on April 23, 2008
European Journal of Echocardiography 2008 9(5):685-691; doi:10.1093/ejechocard/jen137
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Investigating the European Society of Cardiology Diastology Guidelines in a practical scenario
1 Division of Cadiology, University of Alberta Hospital, 2C2 WMC, 8840 112 Street, Edmonton, Alta, Canada T6G 2B7
2 Adult Echocardiography Laboratory, University of Alberta Hospital, Edmonton, Alta, Canada T6G 2B7
Received 21 December 2007; accepted after revision 9 March 2008; online publish-ahead-of-print 23 April 2008.
* Corresponding author. Airedale General Hospital, Skipton Road, Steeton, Keighley, West Yorkshire, BD20 6TD, UK. Tel: +44 1535 293016; fax: +44 1535 292019. E-mail address: richardlawrance{at}hotmail.com
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Abstract |
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Aims: Recently, the European Society of Cardiology (ESC) released a consensus statement for the diagnosis of heart failure with preserved ejection fraction (HFPEF). It state that E/e' > 15 or <8 clearly define those with or without HFPEF and that for those in the range 8–15, other parameters should be examined.
Methods and results: We retrospectively analysed 1229 consecutive echocardiograms (57% males) for the utility of echocardiographic measures including left atrial volume index (LAVI), left ventricular mass index (LVMI), and pulmonary venous and mitral inflow Doppler. LAVI of 40 ml/m2 provided the greatest sensitivity and specificity of 76 and 77%, respectively, with reference to E/e' for the detection of diastolic dysfunction. The ESC definition of raised LVMI yielded a sensitivity and specificity of 32 and 99%, respectively. We found that the mitral and pulmonary inflow provided little incremental information. These results remained consistent between those with normal and abnormal ejection fraction.
Conclusions: There appears to be little incremental value of pulmonary and mitral Doppler measures beyond the measure of mitral E wave. An LAVI cut-off of 40 ml/m2 maximizes both sensitivity and specificity. However, ESC guidelines of raised LVMI in patients with HFPEF would appear to heavily trade sensitivity for specificity.
Keywords: Diastology; Left ventricular end-diastolic pressure; Heart failure with preserved ejection fraction
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