Division of Cardiology, University of British Columbia, Vancouver, Canada.
Department of Medicine, University of British Columbia, Vancouver, Canada.
Int J Cardiol. 2021 Mar 1;326:124-130. doi: 10.1016/j.ijcard.2020.10.068. Epub 2020 Oct 31.
Echocardiographic assessment of diastolic function is complex but can aid in the diagnosis of heart failure, particularly in patients with preserved ejection fraction. In 2016, the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) published an updated algorithm for the evaluation of diastolic function. The objective of our study was to assess its impact on diastolic function assessment in a real-world cohort of echo studies.
We retrospectively identified 71,727 consecutive transthoracic echo studies performed at a tertiary care center between February 2010 and March 2016 in which diastolic function was reported based on the 2009 ASE Guidelines. We then programmed a software algorithm to assess diastolic function in these echo studies according to the 2016 ASE/EACVI Guidelines.
When diastolic function assessment based on the 2009 guidelines was compared to that using the 2016 guidelines, there were significant differences in proportion of studies classified as normal (23% vs. 32%) or indeterminate (43% vs. 36%) function, and mild (23% vs. 23%), moderate (10% vs. 8%), or severe (1% vs. 2%) diastolic dysfunction, with poor agreement between the two methods (Kappa 0.323, 95% CI 0.318-0.328). Furthermore, within the subgroup of studies with preserved ejection fraction and no evidence of myocardial disease, there was significant reclassification from mild diastolic dysfunction to normal diastolic function.
The updated guidelines result in significant differences in diastolic function interpretation in the real world. Our findings have important implications for the identification of patients with or at risk for heart failure.
超声心动图评估舒张功能较为复杂，但有助于心力衰竭的诊断，尤其是射血分数保留的心力衰竭患者。2016 年，美国超声心动图学会（ASE）和欧洲心血管影像学会（EACVI）发布了评估舒张功能的更新算法。我们的研究目的是评估该算法在真实世界超声心动图研究人群中对舒张功能评估的影响。
我们回顾性地确定了 2010 年 2 月至 2016 年 3 月在一家三级护理中心进行的连续 71727 例经胸超声心动图检查，这些检查根据 2009 年 ASE 指南报告了舒张功能。然后，我们编写了一个软件算法，根据 2016 年 ASE/EACVI 指南评估这些超声心动图中的舒张功能。
当根据 2009 年指南进行的舒张功能评估与使用 2016 年指南进行的评估进行比较时，分类为正常（23%比 32%）或不确定（43%比 36%）功能以及轻度（23%比 23%）、中度（10%比 8%）或重度（1%比 2%）舒张功能障碍的研究比例存在显著差异，两种方法之间的一致性较差（Kappa 0.323，95%CI 0.318-0.328）。此外，在射血分数保留且无心肌疾病证据的研究亚组中，轻度舒张功能障碍向正常舒张功能的重新分类具有显著意义。
更新后的指南导致在现实世界中舒张功能解读存在显著差异。我们的研究结果对识别心力衰竭患者或有心力衰竭风险的患者具有重要意义。
