Setti Martina, Benfari Giovanni, Mele Donato, Rossi Andrea, Ballo Piercarlo, Galderisi Maurizio, Henein Michael, Nistri Stefano
Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy.
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy.
Diagnostics (Basel). 2020 Oct 20;10(10):850. doi: 10.3390/diagnostics10100850.
Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number.
We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without ( = 644) or with ( = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a'-ratio (LAVi/a') over indeterminate grading was assessed.
The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN ( < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a', with the latter being the single most effective parameter.
Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a' emerges as a simple and effective approach to this aim.
美国超声心动图学会和欧洲心血管影像协会（ASE/EACVI）关于舒张功能（DF）的现行指南存在争议，Johansen等人和Oh等人提出了两种替代算法。我们旨在（a）使用这些提议的替代方法评估ASE/EACVI关于DF的指南的一致性，以及（b）通过每种方法评估不确定舒张功能障碍（DD）的患病率，探索减少其数量的方法。
我们回顾性分析了1158例门诊患者的超声心动图报告，包括无（n = 644）或有（n = 241）结构性心脏病的心力衰竭风险患者，以及273名健康个体。使用k系数和DD重新分类率的总体比例计算一致性。评估了肺静脉血流（PVF）、瓦尔萨尔瓦动作和左心房容积指数/舒张晚期a'比值（LAVi/a'）对不确定分级的有效性。
ASE/EACVI与Oh方法的DD重新分类率为30.1%（k = 0.35），ASE/EACVI与Johansen方法的为36.5%（k = 0.27），Oh与Johansen方法的为31.1%（k = 0.37）（所有比较P < 0.0001）。分别有9%和11%的患者仅根据ASE/EACVI和Oh方法无法对DF进行分级。大多数患者可以使用PVF或瓦尔萨尔瓦动作或LAVi/a'进行重新分类，其中LAVi/a'是最有效的单一参数。
更新后的指南与评估和分级DF的独立方法之间的不一致阻碍了它们在临床中的互换使用。大多数患者的不确定诊断可以通过传统超声心动图得到解决，LAVi/a'是实现这一目标的一种简单有效的方法。
