Author + information
Diastolic dysfunction (DD) is a common condition. Algorithms for non-invasive diagnosis are not yet sufficiently validated. We aimed to examine the performance of eight echocardiographic schemes for diagnosis and grading of DD in diagnostically naïve patients. The main objectives were to study (a) the pairwise concordance of the classification schemes, (b) the cross sectional correlations between classifications and functional data, and (c) the prognostic power of the classifications.
Design and Setting: Multi-center cohort study. Outcomes: (a) DD (yes/no) and grade of DD (normal, according to 8 classification schemes (see references), (b) six-minute walk distance (6MWD) and self reported physical functioning (PF, scale from 0=worst to 100=best), (c) cardiovascular hospitalization within 2 years after the examination for DD. Participants: 526 subjects (68+/-7 years, 47% female) with at least one risk factor for heart failure, preserved ejection fraction and no previous diagnosis of ventricular dysfunction.
(a) Concordance was moderate for references 4,5,6 (pairwise kappa 0.56-0.74), and poor for all other pairs of schemes (kappa < 0.50). (b) DD, as compared to normal diastolic function, was associated with reduced 6MWD for all schemes except ref 2 (−113 to −34m, p=0.045 or less) and PF for schemes 1,3,4,6 (−22 to −5 points; p=0.016 or less). Grading of DD was associated with 6MWD only for schemes 1,4,6 (all p<0.001) and PF for schemes 4,5,6 (p<0.045 or less). (c) DD as classified by each of the schemes was not prognostic for hospitalization.
In view of the modest correlations of several DD classifications schemes with each other and also with clinical data, such schemes should be thoroughly validated to properly reflect the concept of DD before they are recommended for routine use.
(1) Garcia et al. J Am Coll Cardiol 1998
(2) Lubien et al. Circulation. 2002
(3) Redfield et al. JAMA 2003
(4) Konduracka et al Eur Heart J. 2007
(5) Stahrenberg et al. Diabetologia 2010
(6) Edelmann et al. Am Heart J. 2011
(7) Nagueh et al. Eur J Echocardiogr 2009
(8) Germing et al. Exp Clin Cardiol 2011
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Insights into Diagnosis and Treatment of Heart Failure with Preserved Ejection Fraction
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1220-279
- 2013 American College of Cardiology Foundation