title: A simple, fast and reproducible echocardiographic approach to grade left ventricular diastolic function.
abstract: The American Society of Echocardiography and European Association of Echocardiography (ASE/EAE) have published an algorithm for the grading of diastolic function. However, the ability to use this algorithm effectively in daily clinical practice has not been investigated. We hypothesized that in some patients it may be difficult to grade diastolic dysfunction with this scheme, since there may be discrepancies in the assessed parameters. The aim of the current study was to test the feasibility of the ASE/EAE algorithm and to compare this with a new Thoraxcenter (TXC) algorithm. The ASE/EAE and TXC algorithms were applied to 200 patients. The ASE/EAE algorithm starts with assessment of diastolic myocardial wall velocities and left atrial (LA) volumes with subsequent assessment of E/A ratio, E-wave deceleration time and pulmonary venous flow. The TXC algorithm reverses these steps, uses LA dimension instead of volume and does not include a Valsalva manoeuvre and pulmonary venous flow. Due to inconsistencies between diastolic myocardial wall velocities and LA volumes and a not covered E/A ratio in the range of 1.5-2 it was not possible to classify 48 % of patients with the ASE/EAE algorithm, as opposed to only 10 % by the TXC algorithm. LA volume was always needed in the ASE/EAE algorithm. In only 64 % of patients LA size was necessary by the TXC algorithm. When LA volume would have been used instead of LA dimension, grading of LV diastolic function would have been different in only 2 % of patients without apparent improvement. Assessment of LA dimension was considerably faster than LA volume. The TXC algorithm to grade LV diastolic dysfunction was compared to the ASE/EAE algorithm simpler, faster, better reproducible and yields a higher diagnostic outcome.
authors: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, Room Bd412, 3015 CE, Rotterdam, The Netherlands. b.m.vandalen@erasmusmc.nl.|Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands. b.m.vandalen@erasmusmc.nl.
authors: Bas M
authors: BM
authors: van Dalen
authors: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, Room Bd412, 3015 CE, Rotterdam, The Netherlands.
authors: Mihai
authors: M
authors: Strachinaru
authors: Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors: Julio
authors: J
authors: van der Swaluw
authors: Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, Room Bd412, 3015 CE, Rotterdam, The Netherlands.
authors: Marcel L
authors: ML
authors: Geleijnse
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016279:Atrial Function, Left; D003971:Diastole; D004452:Echocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: Diastolic dysfunction; Diastolic function; Echocardiography