Tatsuya Miyoshi1, Karima Addetia2, Rodolfo Citro3, Masao Daimon4, Sameer Desale1, Pedro Gutierrez Fajardo5, Ravi R Kasliwal6, James N Kirkpatrick7, Mark J Monaghan8, Denisa Muraru9, Kofo O Ogunyankin10, Seung Woo Park11, Ricardo E Ronderos12, Anita Sadeghpour13, Gregory M Scalia14, Masaaki Takeuchi15, Wendy Tsang16, Edwin S Tucay17, Ana Clara Tude Rodrigues18, Amuthan Vivekanandan19, Yun Zhang20, Alexandra Blitz21, Roberto M Lang2, Federico M Asch22. 1. MedStar Health Research Institute, Washington, D.C. 2. University of Chicago, Chicago, Illinois. 3. University of Salerno, Salerno, Italy. 4. University of Tokyo, Tokyo, Japan. 5. Hospital Bernardette, Guadalajara, Jalisco, Mexico. 6. Medanta Medicity, Gurgoan, Haryana, India. 7. University of Washington, Seattle, Washington. 8. King's College Hospital, London, United Kingdom. 9. Istituto Auxologico Italiano, IRCCS, San Luca Hospital, and Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. 10. First Cardiology Consultants Hospital Ikoyi, Lagos, Nigeria. 11. Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 12. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 13. Rajaie Cardiovascular Medical and Center, Echocardiography Research Center, IUMS, Tehran, Iran. 14. GenesisCare, Brisbane, Australia. 15. University of Occupational and Environmental Health, Kitakyushu, Japan. 16. Toronto General Hospital/University of Toronto, Toronto, Ontario, Canada. 17. Philippine Heart Center, Quezon City, Philippines. 18. Hospital Israelita Albert Einstein, São Paulo, Brazil. 19. Jeyalakshmi Heart Center, Madurai, India. 20. Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China. 21. TOMTEC Imaging Systems GmbH, Unterschleissheim, Germany. 22. MedStar Health Research Institute, Washington, D.C.. Electronic address: federico.asch@medstar.net.
Abstract
BACKGROUND: The World Alliance Societies of Echocardiography (WASE) study was conducted to describe echocardiographic normal values in adults and to compare races and nationalities using a uniform acquisition and measurement protocol. This report focuses on left ventricular (LV) diastolic function. METHODS: WASE is an international, cross-sectional study. Participants were enrolled with equal distribution according to age and gender. Echocardiograms were analyzed in a core laboratory based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Left ventricular diastolic function was assessed by E, E/A, e' velocities, E/e', left atrial volume index (LAVI), and tricuspid regurgitation velocity. Determination of LV diastolic function was made using the algorithm proposed by the guidelines. RESULTS: A total of 2,008 subjects from 15 countries were enrolled. The majority were of white or Asian race (42.8%, 41.8%, respectively). E and E/e' were higher in female patients, while LAVI was similar in both genders. Consistent increase in E/e' and decrease in E/A, E, and e' were found as age increased. The upper limit of normal for LAVI was higher in WASE compared with the guidelines. The lower limits of normal for e' were smaller in elder groups than those in the guidelines, while the upper limits of normal for E/e' were below the guideline values. These findings suggest that the cutoff value for LAVI should be shifted upward and age-specific cutoff values for e' should be considered. In WASE, <93.6% of patients were classified as normal LV diastolic function using the guidelines' algorithm, and the proportion increased to 97.4% when applying the revised cutoff values for LAVI obtained in our study. CONCLUSIONS: Guideline-recommended normal values for e' velocities and LAVI should be reconsidered. The algorithm for the determination of LV diastolic function proposed by the guidelines is useful, but adjustments to LAVI could further improve it.
BACKGROUND: The World Alliance Societies of Echocardiography (WASE) study was conducted to describe echocardiographic normal values in adults and to compare races and nationalities using a uniform acquisition and measurement protocol. This report focuses on left ventricular (LV) diastolic function. METHODS: WASE is an international, cross-sectional study. Participants were enrolled with equal distribution according to age and gender. Echocardiograms were analyzed in a core laboratory based on the latest American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Left ventricular diastolic function was assessed by E, E/A, e' velocities, E/e', left atrial volume index (LAVI), and tricuspid regurgitation velocity. Determination of LV diastolic function was made using the algorithm proposed by the guidelines. RESULTS: A total of 2,008 subjects from 15 countries were enrolled. The majority were of white or Asian race (42.8%, 41.8%, respectively). E and E/e' were higher in female patients, while LAVI was similar in both genders. Consistent increase in E/e' and decrease in E/A, E, and e' were found as age increased. The upper limit of normal for LAVI was higher in WASE compared with the guidelines. The lower limits of normal for e' were smaller in elder groups than those in the guidelines, while the upper limits of normal for E/e' were below the guideline values. These findings suggest that the cutoff value for LAVI should be shifted upward and age-specific cutoff values for e' should be considered. In WASE, <93.6% of patients were classified as normal LV diastolic function using the guidelines' algorithm, and the proportion increased to 97.4% when applying the revised cutoff values for LAVI obtained in our study. CONCLUSIONS: Guideline-recommended normal values for e' velocities and LAVI should be reconsidered. The algorithm for the determination of LV diastolic function proposed by the guidelines is useful, but adjustments to LAVI could further improve it.