Diastolic function assessment in clinical practice: The value of 2-dimensional echocardiography
Received 17 February 2007; accepted 19 March 2007. published online 28 April 2007.
Background
The aim of this study was to test the hypothesis that diastolic dysfunction associated with increased filling pressures is unlikely in a structurally normal heart and to assess whether 2-dimensional echocardiography can facilitate diastolic function grading in a clinical setting.
Methods
Consecutive patients referred for transthoracic echocardiography received a comprehensive Doppler echocardiographic evaluation of diastolic function and measurements of left ventricular ejection fraction (EF) by biplane Simpson's method, left atrial volume index (LAVI) by area-length method, and interventricular septal thickness (IVS) from 2-dimensional images. Patients with atrial fibrillation, cardiac pacemaker, severe mitral regurgitation, or mitral prosthesis were excluded.
Results
Of 187 patients, 38 had normal diastolic function and 77 had grade I; 54, grade II; and 18, grade III diastolic dysfunction. The presence of any 2-dimensional abnormality (EF <55%, IVS ≥14 mm, LAVI ≥40 mL/m2) identified any diastolic dysfunction (grade I-III) with 92.6% sensitivity and 92.1% specificity. In a receiver operating characteristic analysis to predict any diastolic dysfunction, the areas under the receiver operating characteristic curve for EF, IVS, and LAVI and the sum of all 3 abnormalities were 0.69, 0.81, 0.87, and 0.95 (all P < .0001), respectively. Among all patients with at least one abnormality, the probability of diastolic dysfunction was 97.9% (138/141). Interpretation of 2-dimensional abnormalities together with the mitral inflow pattern resulted in correct diastolic function grading in 98.4% (184/187).
Conclusions
Structural abnormalities on 2-dimensional echocardiography are not only statistically associated with diastolic dysfunction, but the combination of LAVI, EF, and IVS is of practical value for diastolic function grading. The presence of any such 2-dimensional abnormality should be considered indicative of diastolic dysfunction.
aDivision of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
bDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Reprint requests: Martin Osranek, MD MSc, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Dr Osranek was supported by postdoctoral fellowships from the American Heart Association (0525771Z), Dallas, TX, and the Austrian Science Fund (Schrödinger Stipend, J2289-B02), Vienna, Austria.
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