Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction

Background Echocardiography is considered the cornerstone of the diagnostic workup of heart failure with preserved ejection fraction. Thus far, validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) echo‐algorithm for evaluation of dias...

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Autores principales:	Arno A. van de Bovenkamp, Vidya Enait, Frances S. de Man, Frank T. P. Oosterveer, Harm Jan Bogaard, Anton Vonk Noordegraaf, Albert C. van Rossum, M. Louis Handoko
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	diagnostics echocardiography heart failure with preserved ejection fraction right heart catheterization Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/8421bb3e5c3b40fa8c6f2af56e8c5a51
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spelling	oai:doaj.org-article:8421bb3e5c3b40fa8c6f2af56e8c5a512021-11-23T11:36:36ZValidation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction10.1161/JAHA.121.0211652047-9980https://doaj.org/article/8421bb3e5c3b40fa8c6f2af56e8c5a512021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021165https://doaj.org/toc/2047-9980Background Echocardiography is considered the cornerstone of the diagnostic workup of heart failure with preserved ejection fraction. Thus far, validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) echo‐algorithm for evaluation of diastolic (dys)function in a patient suspected of heart failure with preserved ejection fraction has been limited. Methods and Results The diagnostic performance of the 2016 ASE/EACVI algorithm was assessed in 204 patients evaluated for unexplained dyspnea or pulmonary hypertension with echocardiogram and right heart catheterization. Invasively measured pulmonary capillary wedge pressure (PCWP) was used as the gold standard. In addition, the diagnostic performance of H2FPEF score and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) were evaluated. There was a poor correlation between indexed left atrial volume, E/e′ (septal and average) or early mitral inflow (E), and PCWP (r=0.25–0.30, P values all <0.01). No correlation was found in our cohort between e′ (septal or lateral) or tricuspid valve regurgitation and PCWP. The correlation between diastolic function grades of the ASE/EACVI algorithm and PCWP was poor (r=0.17, P<0.05). The ASE/EACVI algorithm had a sensitivity and specificity of 35% and 87%, respectively; an accuracy of 67% and an area under the curve of 0.56. Moreover, in 30% of cases the algorithm was not applicable or indeterminate. H2FPEF score had a modest correlation with PCWP (r=0.44, P<0.0001), and accuracy was 73%; NT‐proBNP correlated weakly with PCWP (r=0.24, P<0.001), and accuracy was 57%. Conclusions The 2016 ASE/EACVI algorithm for the assessment of diastolic function has a limited diagnostic accuracy in patients evaluated for unexplained dyspnea and/or pulmonary hypertension, and especially sensitivity to detect diastolic dysfunction was low.Arno A. van de BovenkampVidya EnaitFrances S. de ManFrank T. P. OosterveerHarm Jan BogaardAnton Vonk NoordegraafAlbert C. van RossumM. Louis HandokoWileyarticlediagnosticsechocardiographyheart failure with preserved ejection fractionright heart catheterizationDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	diagnostics echocardiography heart failure with preserved ejection fraction right heart catheterization Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	diagnostics echocardiography heart failure with preserved ejection fraction right heart catheterization Diseases of the circulatory (Cardiovascular) system RC666-701 Arno A. van de Bovenkamp Vidya Enait Frances S. de Man Frank T. P. Oosterveer Harm Jan Bogaard Anton Vonk Noordegraaf Albert C. van Rossum M. Louis Handoko Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction
description	Background Echocardiography is considered the cornerstone of the diagnostic workup of heart failure with preserved ejection fraction. Thus far, validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) echo‐algorithm for evaluation of diastolic (dys)function in a patient suspected of heart failure with preserved ejection fraction has been limited. Methods and Results The diagnostic performance of the 2016 ASE/EACVI algorithm was assessed in 204 patients evaluated for unexplained dyspnea or pulmonary hypertension with echocardiogram and right heart catheterization. Invasively measured pulmonary capillary wedge pressure (PCWP) was used as the gold standard. In addition, the diagnostic performance of H2FPEF score and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) were evaluated. There was a poor correlation between indexed left atrial volume, E/e′ (septal and average) or early mitral inflow (E), and PCWP (r=0.25–0.30, P values all <0.01). No correlation was found in our cohort between e′ (septal or lateral) or tricuspid valve regurgitation and PCWP. The correlation between diastolic function grades of the ASE/EACVI algorithm and PCWP was poor (r=0.17, P<0.05). The ASE/EACVI algorithm had a sensitivity and specificity of 35% and 87%, respectively; an accuracy of 67% and an area under the curve of 0.56. Moreover, in 30% of cases the algorithm was not applicable or indeterminate. H2FPEF score had a modest correlation with PCWP (r=0.44, P<0.0001), and accuracy was 73%; NT‐proBNP correlated weakly with PCWP (r=0.24, P<0.001), and accuracy was 57%. Conclusions The 2016 ASE/EACVI algorithm for the assessment of diastolic function has a limited diagnostic accuracy in patients evaluated for unexplained dyspnea and/or pulmonary hypertension, and especially sensitivity to detect diastolic dysfunction was low.
format	article
author	Arno A. van de Bovenkamp Vidya Enait Frances S. de Man Frank T. P. Oosterveer Harm Jan Bogaard Anton Vonk Noordegraaf Albert C. van Rossum M. Louis Handoko
author_facet	Arno A. van de Bovenkamp Vidya Enait Frances S. de Man Frank T. P. Oosterveer Harm Jan Bogaard Anton Vonk Noordegraaf Albert C. van Rossum M. Louis Handoko
author_sort	Arno A. van de Bovenkamp
title	Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction
title_short	Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction
title_full	Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction
title_fullStr	Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction
title_full_unstemmed	Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction
title_sort	validation of the 2016 ase/eacvi guideline for diastolic dysfunction in patients with unexplained dyspnea and a preserved left ventricular ejection fraction
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/8421bb3e5c3b40fa8c6f2af56e8c5a51
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Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction

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