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Clinical and echocardiographic characteristics of patients in sinus rhythm, normal left ventricular function, and indeterminate diastolic function
Author(s) -
Shimron Matan,
Williams Lynne,
Hazanov Yevgeni,
Ghanim Diab,
Kinany Wadia,
Amir Offer,
Carasso Shemy
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13838
Subject(s) - cardiology , medicine , sinus rhythm , diastole , ejection fraction , heart failure , diastolic function , diastolic heart failure , atrial fibrillation , blood pressure
Background Diastolic dysfunction ( DDF x) is the major underlying mechanism of heart failure with preserved left ventricular ejection fraction ( EF ). Yet, the echocardiographic diagnosis of DDF x in patients in sinus rhythm is challenging and up to 25% of studies have discrepant measures making assessment of DDF x 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/Eʹ ratio and left atrial systolic diameter: normal diastolic function ( DF x) (left atrial systolic diameter [ LAS d] <40 mm, E/Eʹ < 10), DDF x ( LAS d ≥ 40 mm, E/Eʹ ≥ 10) and indeterminate DF x (discrepant LAS d diameter and E/Eʹ ratio). Results Clinical and echocardiographic characteristics of the 3 groups, DDF x (n = 186), indeterminate diastolic function (Indt DF x) (n = 207), and normal diastolic function ( NDF x) (n = 1281) were significantly different. Indt DF x demonstrated intermediate parameter abnormalities, largely overlapping with DDF x. LAS d and E/Eʹ were similarly associated with the inability to determine diastolic function. Age, female gender, renal failure, E/Eʹ 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 Indt DF x are more closely related to DD fx than to NDF x. Although LA d was abnormal in Indt DF x 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.