title: Grading diastolic function by echocardiography: hemodynamic validation of existing guidelines.
abstract: BACKGROUND
  While echocardiographic grading of left ventricular (LV) diastolic dysfunction (DD) is used every day, the relationship between echocardiographic DD grade and hemodynamic abnormalities is uncertain.
  
  
  METHODS
  We identified 460 consecutive patients who underwent transthoracic echocardiography within 24 h of elective left heart catheterization and had: normal sinus rhythm, no confounding structural heart disease, no change in medications between catheterization and echo, and complete echocardiographic data. Patients were grouped based on echocardiographic DD grade. Hemodynamic tracings were used to determine time constant of isovolumic pressure decay (Tau), LV end-diastolic pressure (LVEDP) and end-diastolic volume index at a pressure of 20 mmHg (EDVi20).
  
  
  RESULTS
  Normal diastolic function was found in 55 (12.0%) patients, while 132 (28.7%) patients had grade 1, 156 (33.9%) grade 2 and 117 (25.4%) grade 3 DD. The median value for Tau was 46.9 ms for the overall population (interquartile range 38.6-58.1 ms), with a prevalence of a prolonged Tau (>48 ms) of 47.5%. While there was an association between DD grade and Tau (p = 0.003), LV dysfunction (ejection fraction <50%) was more strongly associated with increased Tau (p < 0.001) than was DD grade (p = 0.19). There was also an association between DD grade and LVEDP (p < 0.001), with both LV dysfunction (p = 0.029) and DD grade (p < 0.001) independently associated with LVEDP. Calculated EDVi20 was related to DD grade, but this relationship was driven by findings of paradoxically increased compliance in patients with severe DD.
  
  
  CONCLUSIONS
  Although echocardiographic grading of DD was related to invasive hemodynamics in this population, the relationship was modest.
authors.affiliation: Libin Cardiovascular Institute, University of Calgary, Calgary, Canada. andrew.grant@albertahealthservices.ca.
authors.forename: Andrew D M
authors.initials: AD
authors.lastname: Grant
authors.affiliation: Menzies Research Institute, University of Tasmania, Tasmania, Australia. kazuaki.negishi@utas.edu.au.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Negishi
authors.affiliation: Menzies Research Institute, University of Tasmania, Tasmania, Australia. tomoko.negishi@utas.edu.au.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Negishi
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA. colliep@ccf.org.
authors.forename: Patrick
authors.initials: P
authors.lastname: Collier
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA. kapadis@ccf.org.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, USA. thomasj@ccf.org.
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.affiliation: Menzies Research Institute, University of Tasmania, Tasmania, Australia. tom.marwick@utas.edu.au.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA. griffib@ccf.org.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA. popoviz@ccf.org.|Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA. popoviz@ccf.org.
authors.forename: Zoran B
authors.initials: ZB
authors.lastname: Popović
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000379:methods* / Q000592:standards*; D005260:Female; D006334:Heart Function Tests / Q000592:standards; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*