title: Effect of Echocardiographic Grading of Left Ventricular Diastolic Dysfunction by Different Classifications in Primary Care.
abstract: The presence of left ventricular (LV) diastolic dysfunction (DD) as characterized by Doppler echocardiography is associated with worse overall mortality both in symptomatic and asymptomatic patients. However, available data on this topic come from referral centers and have been obtained by different, validated algorithms for each single study. Thus, we aimed at determining the feasibility of comprehensive evaluation of LVDD in a primary care outpatient setting and at testing the concordance of different methodological approaches in grading diastolic dysfunction. Eight hundred eighty-five consecutive outpatients, in sinus rhythm, prospectively underwent Doppler echocardiography according to a predetermined protocol. Feasibility of each LV diastolic index and concordance between 3 methods to determine the degree of LVDD, namely the American Society of Echocardiography/European Association of Echocardiography (ASE/EAE) recommendations, the Olmstead County, and the Canberra Study protocols, were tested. Feasibility of all diastolic indexes was high, ranging from 93% of Valsalva maneuver to ≥99% for mitral inflow and tissue Doppler parameters. Diastolic function was not classifiable in 6% to 19% of patients. The concordance for LV diastolic dysfunction degree was fair when comparing the classification of the ASE/EAE with those from Olmstead County (κ = 0.25; reclassification rate 51%) and Canberra Study (κ = 0.27; reclassification rate 43.7%), and was good for the comparison between the Olmstead County and Canberra classifications (κ = 0.68, reclassification rate 27%). In conclusion, feasibility of LV diastolic function measurements is very high and grading diastolic dysfunction is possible in most patients in primary care settings. Substantial differences, however, exist when concordance is tested among 3 documented criteria, resulting in poor concordance of data interpretation and hence patient stratification and clinical management.
authors.affiliation: Cardiology Service CMSR Veneto Medica, Altavilla Vicentina, Italy. Electronic address: snistr@tin.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nistri
authors.affiliation: Cardiology Unit, S. Maria Annunziata Hospital, Florence, Italy.
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Ballo
authors.affiliation: Department of Cardiology, University of Ferrara, Ferrera, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Mele
authors.affiliation: Cardiology Service CMSR Veneto Medica, Altavilla Vicentina, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Papesso
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
authors.affiliation: Cardiology Service ASL Napoli 3 Sud, Pompei, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Zito
authors.affiliation: Umeå University and Heart Centre, Umeå, Sweden.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Henein
mesh_terms: D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011320:Primary Health Care; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000145:classification* / Q000000981:diagnostic imaging*