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Clinical and echocardiographic characteristics of patients in sinus rhythm, normal left ventricular function, and indeterminate diastolic function.
Echocardiography. 2018 06; 35(6):792-797.E

Abstract

BACKGROUND

Diastolic dysfunction (DDFx) is the major underlying mechanism of heart failure with preserved left ventricular ejection fraction (EF). Yet, the echocardiographic diagnosis of DDFx in patients in sinus rhythm is challenging and up to 25% of studies have discrepant measures making assessment of DDFx indeterminate. We aimed to describe the clinical and echocardiographic characteristics of patients with indeterminate diastolic function compared to patients with definite normal and abnormal diastolic function.

METHODS

One thousand six hundred seventy-four patients were identified from the echocardiography database in sinus rhythm, EF ≥ 45% without wall-motion abnormalities, valvular, congenital heart diseases, cardiomyopathies or pulmonary disease. Patients were divided according to their lateral mitral E/E' ratio and left atrial systolic diameter: normal diastolic function (DFx) (left atrial systolic diameter [LASd] <40 mm, E/E' < 10), DDFx (LASd ≥ 40 mm, E/E' ≥ 10) and indeterminate DFx (discrepant LASd diameter and E/E' ratio).

RESULTS

Clinical and echocardiographic characteristics of the 3 groups, DDFx (n = 186), indeterminate diastolic function (IndtDFx) (n = 207), and normal diastolic function (NDFx) (n = 1281) were significantly different. IndtDFx demonstrated intermediate parameter abnormalities, largely overlapping with DDFx. LASd and E/E' were similarly associated with the inability to determine diastolic function. Age, female gender, renal failure, E/E' and pulmonary pressure were found to be independent predictors of heart failure symptoms (RR = 1.02, 1.5, 2.5, 1.1, 1.1, respectively, P < .0001, r = .35).

CONCLUSION

Clinically and echocardiographically patients with IndtDFx are more closely related to DDfx than to NDFx. Although LAd was abnormal in IndtDFx it was not predictive of heart failure symptoms. Further study is suggested to establish whether LA function rather than its maximal size can provide additional information.

Authors+Show Affiliations

Department of Cardiology, B Padeh Medical Center, Poriya, Israel. Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK.Department of Cardiology, B Padeh Medical Center, Poriya, Israel. Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.Department of Cardiology, B Padeh Medical Center, Poriya, Israel. Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.Department of Cardiology, B Padeh Medical Center, Poriya, Israel. Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.Department of Cardiology, B Padeh Medical Center, Poriya, Israel. Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.Department of Cardiology, B Padeh Medical Center, Poriya, Israel. Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29457270

Citation

Shimron, Matan, et al. "Clinical and Echocardiographic Characteristics of Patients in Sinus Rhythm, Normal Left Ventricular Function, and Indeterminate Diastolic Function." Echocardiography (Mount Kisco, N.Y.), vol. 35, no. 6, 2018, pp. 792-797.
Shimron M, Williams L, Hazanov Y, et al. Clinical and echocardiographic characteristics of patients in sinus rhythm, normal left ventricular function, and indeterminate diastolic function. Echocardiography. 2018;35(6):792-797.
Shimron, M., Williams, L., Hazanov, Y., Ghanim, D., Kinany, W., Amir, O., & Carasso, S. (2018). Clinical and echocardiographic characteristics of patients in sinus rhythm, normal left ventricular function, and indeterminate diastolic function. Echocardiography (Mount Kisco, N.Y.), 35(6), 792-797. https://doi.org/10.1111/echo.13838
Shimron M, et al. Clinical and Echocardiographic Characteristics of Patients in Sinus Rhythm, Normal Left Ventricular Function, and Indeterminate Diastolic Function. Echocardiography. 2018;35(6):792-797. PubMed PMID: 29457270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and echocardiographic characteristics of patients in sinus rhythm, normal left ventricular function, and indeterminate diastolic function. AU - Shimron,Matan, AU - Williams,Lynne, AU - Hazanov,Yevgeni, AU - Ghanim,Diab, AU - Kinany,Wadia, AU - Amir,Offer, AU - Carasso,Shemy, Y1 - 2018/02/19/ PY - 2018/2/20/pubmed PY - 2018/11/6/medline PY - 2018/2/20/entrez KW - cardiac function KW - echocardiography KW - heart failure SP - 792 EP - 797 JF - Echocardiography (Mount Kisco, N.Y.) JO - Echocardiography VL - 35 IS - 6 N2 - BACKGROUND: Diastolic dysfunction (DDFx) is the major underlying mechanism of heart failure with preserved left ventricular ejection fraction (EF). Yet, the echocardiographic diagnosis of DDFx in patients in sinus rhythm is challenging and up to 25% of studies have discrepant measures making assessment of DDFx indeterminate. We aimed to describe the clinical and echocardiographic characteristics of patients with indeterminate diastolic function compared to patients with definite normal and abnormal diastolic function. METHODS: One thousand six hundred seventy-four patients were identified from the echocardiography database in sinus rhythm, EF ≥ 45% without wall-motion abnormalities, valvular, congenital heart diseases, cardiomyopathies or pulmonary disease. Patients were divided according to their lateral mitral E/E' ratio and left atrial systolic diameter: normal diastolic function (DFx) (left atrial systolic diameter [LASd] <40 mm, E/E' < 10), DDFx (LASd ≥ 40 mm, E/E' ≥ 10) and indeterminate DFx (discrepant LASd diameter and E/E' ratio). RESULTS: Clinical and echocardiographic characteristics of the 3 groups, DDFx (n = 186), indeterminate diastolic function (IndtDFx) (n = 207), and normal diastolic function (NDFx) (n = 1281) were significantly different. IndtDFx demonstrated intermediate parameter abnormalities, largely overlapping with DDFx. LASd and E/E' were similarly associated with the inability to determine diastolic function. Age, female gender, renal failure, E/E' and pulmonary pressure were found to be independent predictors of heart failure symptoms (RR = 1.02, 1.5, 2.5, 1.1, 1.1, respectively, P < .0001, r = .35). CONCLUSION: Clinically and echocardiographically patients with IndtDFx are more closely related to DDfx than to NDFx. Although LAd was abnormal in IndtDFx it was not predictive of heart failure symptoms. Further study is suggested to establish whether LA function rather than its maximal size can provide additional information. SN - 1540-8175 UR - https://www.unboundmedicine.com/medline/citation/29457270/Clinical_and_echocardiographic_characteristics_of_patients_in_sinus_rhythm_normal_left_ventricular_function_and_indeterminate_diastolic_function_ L2 - https://doi.org/10.1111/echo.13838 DB - PRIME DP - Unbound Medicine ER -