Journal of the American Society of Echocardiography
Clinical InvestigationDiastolic FunctionDifferential Clinical Implications of Current Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography
Section snippets
Patients
We evaluated a cohort of consecutive outpatients with suspected new onset of HF and first consultation in our one-stop clinic between 2009 and 2014. The patients belonged to a cohort that was prospectively enrolled and followed to study characteristics and outcomes of outpatients with new onset of HF in our area.9, 10 A clinical evaluation, electrocardiography, blood test analysis with BNP determination (ADVIA Centaur; Siemens Healthcare Diagnostics, Tarrytown, NY; cutoff value 37 pg/mL), and a
Results
Two hundred fourteen consecutive patients evaluated in our one-stop clinic between 2009 and 2014 were screened. Fifty-seven patients were excluded because of the presence of atrial fibrillation, pacemaker, or severe mitral valve disease. Ultimately, 157 patients were included in the study cohort. Seventy-six patients (48.4%) were diagnosed with HF (71.1% [n = 54] with HF with preserved ejection fraction and 28.9% [n = 22] with HF with reduced ejection fraction). Table 1 summarizes baseline
Discussion
The main finding of our study is that after LVDF reclassification with the new recommendations,4 most of the patients initially classified with grade I DD were reassigned to other groups, mainly to normal diastolic function (49%). These patients showed lower BNP levels (40.8 pg/mL) and a lower proportion of final diagnosis of HF (9.6%), suggesting a better classification with the use of the 2016 recommendations. An important proportion of patients initially classified as having grade DD (31.1%)
Conclusion
The 2016 guideline update for the evaluation of LVDF using echocardiography resulted in a more accurate classification of patients from diagnostic and prognostic perspectives, especially those patients previously classified as having grade I LV DD. Reclassification of patients adds a clinically relevant association with surrogates and outcomes related to HF, such as BNP levels and cardiovascular outcomes.
Acknowledgments
The authors acknowledge the CERCA Programme/Generalitat de Catalunya.
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Conflicts of Interest: None.