Author + information
- Matthew Auyoung,
- Marina Trilesskaya,
- Thomas Frohlich,
- Clare Waterloo,
- Darwin Pastor,
- Donovan Huynh and
- Sophie Barbant
Background: The new 2016 American Society of Echocardiography (ASE) guidelines aim to improve echocardiographic evaluation of diastolic dysfunction (DD) and left ventricular filling pressure (LVFP). The goal of this study was to compare DD severity grading and estimated LVFP using algorithms from ASE 2009 and 2016, with left ventricular end-diastolic pressure (LVEDP) measured by left heart cardiac catheterization (LHC) as a gold standard.
Methods: 54 consecutive patients underwent non-emergent LHC with simultaneous echocardiography. Patients with concurrent atrial fibrillation, significant mitral valvular disease and pulmonary arterial hypertension were excluded. DD by echo was graded as Normal (low LVEDP), Grade I (mild DD/low LVEDP), Grade II (moderate DD/high LVEDP), Grade III (severe DD/high LVEDP) or Indeterminate. Results were deemed concordant if low or high estimated LVEDP by echo matched results of LHC.
Results: Mean age was 58 (31.5% female). 68.5% had normal ejection fraction. 17/54 (31.4%) patients had unchanged grades under ASE 2009 and 2016, including all patients with Grade III DD. Overall concordance with LHC did not increase significantly: 57% (ASE 2009) vs 61% (ASE 2016), p=0.84.
Sensitivity for detecting high LVEDP, specificity, positive predictive value, and negative predictive value were: 0.71, 0.37, 0.71, 0.74 for ASE 2009 and 0.33, 0.83, 0.89, 0.68 for ASE 2016.
All patients (11) with Indeterminate grading under ASE 2009 had an E/A ratio less than 0.8 but with high E/e', 9 of them with low LVEDP. 7/11 patients were given a specific grade under ASE 2016 with concordant low LVEDP.
The majority of patients with grade designation were downgraded (13/54) with no significant net change in concordance.
Conclusions: Concordance between estimated and measured LVEDP did not differ significantly between ASE 2009 and 2016, although specificity was noted to markedly increased at the expense of sensitivity. The majority of previously ungraded patients with low E/A ratio but high E/e’ was observed to have low LVEDP and acquired an appropriate grade designation under new guidelines.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Novel Echocardiographic Methods for Assessing Cardiac Function
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1120-235
- 2017 American College of Cardiology Foundation