Poor concordance of commonly used echocardiographic measures of left ventricular diastolic function in patients with suspected heart failure but preserved systolic function: is there a reliable echocardiographic measure of diastolic dysfunction?
OBJECTIVE
To determine the concordance of different Doppler echocardiographic criteria for "diastolic dysfunction" in patients with suspected heart failure but preserved left ventricular systolic function.


METHODS
Prospective, descriptive study.


METHODS
Outpatient based direct access echocardiography service.


METHODS
Consecutive patients referred with suspected heart failure but preserved left ventricular systolic function.


METHODS
Echocardiographic measurements of systolic and diastolic function. Eight published studies giving age and sex specific ranges for measures of diastolic function in healthy subjects were reviewed and the proportion of patients outside the normal limits for each of these published ranges was calculated.


RESULTS
There was very poor concordance between measures with up to a 16-fold difference in the prevalence of diastolic dysfunction in the overall patient cohort. Even for a given measure, there was relatively poor agreement between the published reference ranges. In subsets likely to include patients at high risk of having diastolic dysfunction, an increased prevalence of diastolic dysfunction was not evident with any measure in any patient subset.


CONCLUSIONS
Our findings challenge the use of the diagnosis of diastolic heart failure based on the most commonly used echocardiographic criteria. Physicians should be cautious about echocardiographic reports describing diastolic dysfunction and only apply the diagnosis of diastolic heart failure with great care.
Petrie
M C
MC
Department of Cardiology, Western Infirmary, Glasgow, UK.
Hogg
K
K
Caruana
L
L
McMurray
J J V
JJ
D000368:Aged; D002303:Cardiac Output, Low / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology