DOI: https://doi.org/10.22263/2312-4156.2020.3.87
Zherko O.M.
Echocardiographic criteria of diastolic dysfunction of the left ventricle and their diagnostic reliability
Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus
Vestnik VGMU. 2020;19(3):87-95.
Abstract.
Objectives. To assess the diagnostic reliability of the echocardiographic criteria of the left ventricle (LV) diastolic dysfunction (DD).
Material and methods. In 2017-2018, a clinical and instrumental examination of 303 patients aged 40-86 years was performed. Inclusion criteria: sinus rhythm, essential arterial hypertension, chronic ischemic heart disease, previous myocardial infarction, chronic heart failure. Exclusion criteria: primary mitral regurgitation, mitral stenosis, plastic surgery or mitral valve replacement, congenital heart disease. Transthoracic echocardiography was performed on the Siemens Acuson S1000 ultrasound machine (Germany).
Results. LV DD type I is diagnosed when the velocity of peak E transmitral blood flow (MV) is ≤0.51 m/s, the value of E/A ≤0.79, a peak deceleration time of peak E (DTE)>200 ms. The prognostic criterion of LV DD type I is the LV myocardial mass index in men ˃133.9 g/m2, in women ˃119.7 g/m2. Diagnostic for DD LV of type II is criteria complex: the ratio E/A MV 0.80-1.86, е′septal peak velocity ≤7 cm/s, LV filling index E/е′septal≥9, tricuspid regurgitation (TR) velocity >2.62 m/s, left atrial (LA) volume index >35.7 ml/m2, additional criteria are LV filling indices E/eʹaverage and E/еʹlateral≥9, е′lateral peak velocity ≤8 cm/sec, LV ejection fraction (EF) ≤53%, pulmonary capillary wedge pressure (PCWP) >11.51 mm Hg, systolic pressure in the pulmonary artery (PA SP) >33.5 mm Hg. When E/A MV >1.86, LV EF ≤49.51%, DD LV type III is diagnosed, the additional criteria being DTE MK≤146 ms, TR velocities ˃2.81 m/s, PCWP ˃13.68 mm Hg, PA SP ˃41,2 mm Hg. When the LV filling index E/е′septal is ˃11.5, the velocity е′septal is ≤6 cm/s, the LA volume index is >43.3 ml/m2, the patient has an elevated LV filling pressure at rest, additional criteria are LV EF ≤49.51%, Ardur-Adur˃32 ms, PCWP ˃13.56 mm Hg, PA SP >31.5 mm Hg.
Conclusions. The criteria for determining LV DD posses high reliability indicators of sensitivity and specificity.
Key words: echocardiography, diastolic dysfunction, left ventricle, chronic heart failure.
References
1. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016 Apr;29(4):277-314. doi: http://dx.doi.org/10.1016/j.echo.2016.01.011
2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Europ Heart J. 2016 Jul;37(27):2129-200. doi: http://dx.doi.org/10.1093/eurheartj/ehw128
3. Ovchinnikov AG, Ageev FT. Ultrasound examination to assess diastolic pressure in the left ventricle. Serdech Nedostatochnost'. 2009;10(4):221-36. (In Russ.)
4. Zherko OM. Left ventricular filling pressure as a hemodynamic mechanism of the progression of chronic heart failure. Zdravookhranenie. 2019;(10):5-9. (In Russ.)
5. Gharacholou SM, Scott CG, Takahashi PY, Nkomo VT, McCully RB, Fine NM, et al. Left Ventricular Diastolic Function and Long-Term Outcomes in Patients With Normal Exercise Echocardiographic Findings. Am J Cardiol. 2013 Jul;112(2):200-7. doi: http://dx.doi.org/10.1016/j.amjcard.2013.03.009
6. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020 Jan;41(3):407-477. doi: http://dx.doi.org/10.1093/eurheartj/ehz425
7. Zhang Y, Bauersachs J, Langer HF. Immune mechanisms in heart failure. Eur J Heart Fail. 2017 Nov;19(11):1379-1389. doi: http://dx.doi.org/10.1002/ejhf.942
8. Kloch-Badelek M, Kuznetsova T, Sakiewicz W, Tikhonoff V, Ryabikov A, González A, et al. Prevalence of left ventricular diastolic dysfunction in European populations based on cross-validated diagnostic thresholds. Cardiovasc Ultrasound. 2012 Mar;10:10. doi: http://dx.doi.org/10.1186/1476-7120-10-10
9. van Dalen BM, Strachinaru M, van der Swaluw J, Geleijnse ML. A simple, fast and reproducible echocardiographic approach to grade left ventricular diastolic function. Int J Cardiovasc Imaging. 2016 May;32(5):743-52. doi: http://dx.doi.org/10.1007/s10554-015-0832-6
10. Otto CM. The practice of clinical echocardiography. 5tn ed. Philadelphia, Pennsylvania: Elsevier; 2016. 1024 р.
11. Жерко ОМ. Клиническая трансторакальная эхокардиография: практ рук для врачей. Минск, РБ: Альфакнига Zherko OM. Clinical transthoracic echocardiography: prakt ruk dlia vrachei. Minsk, RB: Al'fakniga; 2016. 832 р. (In Russ.)
12. Zherko OM, Oliferko NP. Global remodeling of the heart with diastolic dysfunction of the left ventricle. Kardiologiia Belarusi. 2019;11(4):603-13. (In Russ.)
13. Zherko OM. Ultrasound diagnosis of elevated resting filling pressure of the left ventricle. Zdravookhranenie. 2019;(11):5-10. (In Russ.)
14. Ostrovskiy YuP, red. Heart failure. Minsk, RB: Belarus navuka; 2016. 503 р. (In Russ.)
15. Lourenço AP, Leite-Moreira AF, Balligand JL, Bauersachs J, Dawson D, de Boer RA5, et al. An integrative translational approach to study heart failure with preserved ejection fraction: a position paper from the Working Group on Myocardial Function of the European Society of Cardiology. Eur J Heart Fail. 2018 Feb;20(2):216-227. doi: http://dx.doi.org/10.1002/ejhf.1059
Information about authors:
Zherko O.M. – Candidate of Medical Sciences, associate professor, head of the Chair of Ultrasound Diagnosis, Belarusian Medical Academy of Post-Graduate Education.
Correspondence address: Republic of Belarus, 220013, Minsk, 3-3 P. Brovki str., Belarusian Medical Academy of Post-Graduate Education, Chair of Ultrasound Diagnosis. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Olga М. Zherko.
