Laura Sanchis1, Rut Andrea2, Carlos Falces2, Silvia Poyatos2, Bàrbara Vidal2, Marta Sitges2. 1. Cardiovascular Clinic Institute, Hospital Clinic, Barcelona University, IDIBAPS, Barcelona, Spain. Electronic address: lsanchis@clinic.cat. 2. Cardiovascular Clinic Institute, Hospital Clinic, Barcelona University, IDIBAPS, Barcelona, Spain.
Abstract
BACKGROUND: Classification of left ventricular diastolic function (LVDF) by echocardiography is controversial. The aim of this study was to evaluate the impact of the last 2016 recommendations for LVDF evaluation on brain natriuretic peptide (BNP) levels, proportion of final heart failure (HF) diagnosis, and cardiovascular outcomes. METHODS: Outpatients with first consultation at a one-stop HF clinic (2009-2014) were screened. The initial visit included echocardiography with LVDF evaluation and determination of BNP level. HF diagnosis was confirmed or ruled out at the end of the visit. Cardiovascular events during follow-up were recorded. LVDF classification was originally performed with the 2009 recommendations and reevaluated using the 2016 recommendations. RESULTS: A total of 157 patients (mean age 73.24 ± 10.3 years; 70.1% women) were included. Originally (2009 recommendations), most of the patients were classified with grade I diastolic dysfunction (DD; 67.5%). After the reanalysis using the 2016 recommendations, 49% were reclassified with normal LVDF. These subjects showed lower BNP levels (40.8 pg/mL) and a lower proportion of HF diagnosis (9.6%). Another part of the initial grade I DD group (31.1%) was reclassified with indeterminate LVDF; they had intermediate BNP levels, proportion of HF, and rate of cardiovascular events. Lower reclassification rates were observed in the other groups of DD. Kaplan-Meier survival curves showed significantly better prognostic stratification after the reclassification (P = .539 vs P = .003). CONCLUSIONS: Current recommendations for the evaluation of LVDF by echocardiography resulted in more accurate classification of patients, according to their BNP levels, HF diagnosis, and cardiovascular outcomes, especially for those patients previously classified with grade I DD.
BACKGROUND: Classification of left ventricular diastolic function (LVDF) by echocardiography is controversial. The aim of this study was to evaluate the impact of the last 2016 recommendations for LVDF evaluation on brain natriuretic peptide (BNP) levels, proportion of final heart failure (HF) diagnosis, and cardiovascular outcomes. METHODS: Outpatients with first consultation at a one-stop HF clinic (2009-2014) were screened. The initial visit included echocardiography with LVDF evaluation and determination of BNP level. HF diagnosis was confirmed or ruled out at the end of the visit. Cardiovascular events during follow-up were recorded. LVDF classification was originally performed with the 2009 recommendations and reevaluated using the 2016 recommendations. RESULTS: A total of 157 patients (mean age 73.24 ± 10.3 years; 70.1% women) were included. Originally (2009 recommendations), most of the patients were classified with grade I diastolic dysfunction (DD; 67.5%). After the reanalysis using the 2016 recommendations, 49% were reclassified with normal LVDF. These subjects showed lower BNP levels (40.8 pg/mL) and a lower proportion of HF diagnosis (9.6%). Another part of the initial grade I DD group (31.1%) was reclassified with indeterminate LVDF; they had intermediate BNP levels, proportion of HF, and rate of cardiovascular events. Lower reclassification rates were observed in the other groups of DD. Kaplan-Meier survival curves showed significantly better prognostic stratification after the reclassification (P = .539 vs P = .003). CONCLUSIONS: Current recommendations for the evaluation of LVDF by echocardiography resulted in more accurate classification of patients, according to their BNP levels, HF diagnosis, and cardiovascular outcomes, especially for those patients previously classified with grade I DD.
Authors: Leah Rethy; Barry A Borlaug; Margaret M Redfield; Jae K Oh; Sanjiv J Shah; Ravi B Patel Journal: J Am Soc Echocardiogr Date: 2021-01-21 Impact factor: 5.251
Authors: Sandhir B Prasad; Kristyan B Guppy-Coles; David Holland; Tony Stanton; Rathika Krishnasamy; Gillian Whalley; John J Atherton; Liza Thomas Journal: Int J Cardiol Heart Vasc Date: 2019-08-03
Authors: David B Hanna; Jason M Lazar; Sriya Avadhani; Robert C Kaplan; Kathryn Anastos; Stephen J Gange; Susan Holman; Howard L Minkoff; Jorge R Kizer Journal: J Am Soc Echocardiogr Date: 2019-01-18 Impact factor: 7.722
Authors: Bethel Woldu; Tecla M Temu; Nicholas Kirui; Bridgette Christopher; Samson Ndege; Wendy S Post; Jemima Kamano; Gerald S Bloomfield Journal: Open Heart Date: 2022-01