A Clinical Study Of Echocardiographic Grading Of Left Ventricular Diastolic Function In Heart Failure With Preserved Ejection Fraction

Objective: To investigate clinical significance of echocardiographic grading of left ventricular diastolic function in heart failure with preserved ejection fraction.Methods: Left ventricular diastolic function was graded using the American Society of Echocardiography(ASE) and European Association of Echocardiography(EAE) recommendations for the evaluation of left ventricular diastolic function by echocardiography(ASE/EAE classification) and the algorithm based on the principle of the joined ASE/EAE recommendations and the measured E/A reference value(modified ASE/EAE classification). One hundred and ninetyfive patients with newly diagnosed heart failure with preserved ejection fraction(HFpEF) were enrolled in the study. Diastolic dysfunction was categorized into three groups by both methods as mild diastolic dysfunction(impaired relaxation pattern), moderate diastolic dysfunction(pseudonormal LV filling pattern) and severe diastolic dysfunction(restrictive LV filling pattern). Clinical data and echocardiographic parameters were compared among the three groups.Results: Seventy-eight point five percent(153 out of 195) of patients with HFpEF could be classified according to the ASE/EAE classification, and diastolic function grading was indeterminated in 21.5%(42/195) of patients. With this metohd diastolic dysfunction was found in 99.3%(152/153) of classified patients, of which 55.5%(85/153) had mild diastolic dysfunction(impaired relaxation), 41.2%(63/153) had moderate diastolic dysfunction(pseudonormal), and 2.6%(4/153) had severe diastolic dysfunction(restrictive pattern). According to the modified ASE/EAE classification, all of the patients could be classified and diastolic dysfunction was present in 96.9%(189/195) of patients and 12.3%(24/195) had mild diastolic dysfunction, 80%(156/195) had moderate diastolic dysfunction, and 4.6%(9/195) had severe diastolic dysfunction. The percentage of mild, moderate and indeterminated patients were statistically different using the two classification methods(all P<0.001). With both classification methods, LAVi, E/E’S and E/E’ were increased with the elevation of diastolic dysfunction grade.Conclusions: Left ventricular diastolic function in HFpEF patients was classified using the ASE/EAE classification and the modified ASE/EAE classification, into the mild and moderate diastolic dysfunction, and sever diastolic dysfunction account for only a small portion of the patients. Significant proportion of patients could not be graded by the ASE/EAE classification, resulting in low efficiency and clinical utility. However, the modified ASE/EAE classification can improve the efficiency, increase the clinical utility. With both classification methods, LAVi, E/E’S and E/E’ were increased with the elevation of diastolic dysfunction grade, which also indicates that the more severe diastolic dysfunction grade, the worse the prognosis.