S Sunil Kumar, Desai Nagaraj, Gona Oliver Joel, K Vinay Kumar, B Madhu
Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India.
Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, India.
J Cardiovasc Imaging. 2021 Jan;29(1):31-43. doi: 10.4250/jcvi.2020.0117.
Assessment of diastolic dysfunction (DD) and left ventricular filling pressures (LVFP) by echocardiography is complex in patients with preserved ejection fraction (EF). The American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) jointly published recommendations in 2016 to simplify the diagnosis and classification of DD and the assessment of LVFP. We aimed to study the impact of the updated 2016 ASE/EACVI guidelines vis-à-vis the 2009 ASE recommendations on prevalence of DD and LVFP in patients with preserved EF.
Five hundred patients referred to the echocardiography laboratory from March 2020 to May 2020 were analyzed. Patients with left ventricular ejection fraction (LVEF) < 50% were excluded. All patients underwent comprehensive transthoracic echocardiography. DD and LVFP were assessed by the 2016 ASE/EACVI and 2009 ASE recommendations. The concordance between the guidelines was analyzed by kappa coefficient and overall proportion of agreement.
Mean age was 53 ± 13 years and 63.4% were men. Prevalence of DD and abnormal LVFP were significantly lower with the 2016 recommendations than with the 2009 recommendations (9.4% vs. 16.8%, p < 0.001 and 8.4% vs. 12.8%, p < 0.05). Patients with Grade 1 DD (100%) and Grade 2 DD (46.4%) were reclassified by the 2016 recommendations. Indeterminate diastolic function (9.8%) was strikingly high according to the 2016 recommendations. The concordance between the two recommendations was moderate (kappa = 0.569). The overall proportion of agreement was 85.4%.
Prevalence of DD and abnormal LV filling pressures were lower with application of the 2016 ASE/EACVI recommendations in patients with preserved EF. There was moderate agreement between the 2009 and 2016 recommendations.
对于射血分数（EF）保留的患者，通过超声心动图评估舒张功能障碍（DD）和左心室充盈压（LVFP）较为复杂。美国超声心动图学会和欧洲心血管影像协会（ASE/EACVI）于2016年联合发布了相关建议，以简化DD的诊断和分类以及LVFP的评估。我们旨在研究2016年更新的ASE/EACVI指南相对于2009年ASE建议对EF保留患者中DD和LVFP患病率的影响。
对2020年3月至2020年5月转诊至超声心动图实验室的500例患者进行分析。排除左心室射血分数（LVEF）<50%的患者。所有患者均接受了全面的经胸超声心动图检查。根据2016年ASE/EACVI和2009年ASE建议评估DD和LVFP。通过kappa系数和总体一致比例分析指南之间的一致性。
平均年龄为53±13岁，男性占63.4%。与2009年建议相比，2016年建议下DD和异常LVFP的患病率显著降低（9.4%对16.8%，p<0.001；8.4%对12.8%，p<0.05）。1级DD（100%）和2级DD（46.4%）的患者根据2016年建议进行了重新分类。根据2016年建议，舒张功能不确定（9.8%）的比例极高。两项建议之间的一致性为中等（kappa=0.569）。总体一致比例为85.4%。
在EF保留的患者中应用2016年ASE/EACVI建议时，DD和异常LV充盈压的患病率较低。2009年和2016年建议之间存在中等程度的一致性。
