Diastolic dysfunction diagnostic criteria: Difference between revisions
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{{CMG}}; '''Assistant Editor(s)-in-Chief:''' [[User:Rim Halaby|Rim Halaby]] | {{CMG}}; '''Assistant Editor(s)-in-Chief:''' [[User:Rim Halaby|Rim Halaby]] | ||
==Overview== | ==Overview== | ||
The evaluation of the presence of [[diastolic dysfunction]] in patients presenting with symptoms of [[heart failure]] is of paramount importance. The diagnosis of diastolic dysfunction or diastolic heart failure is not clinical and requires a work up that goes beyond the history, physical exam, [[echocardiography]] and chest X-rays. Several studies have evaluated the diagnostic criteria to follow in differentiating [[systolic dysfunction]] from [[diastolic dysfunction]]. | The evaluation of the presence of [[diastolic dysfunction]] in patients presenting with symptoms of [[heart failure]] is of paramount importance. | ||
The accuracy of clinicians to diagnose diastolic dysfunction has been questioned<ref name="pmid10903655">{{cite journal| author=Caruana L, Petrie MC, Davie AP, McMurray JJ| title=Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study. | journal=BMJ | year= 2000 | volume= 321 | issue= 7255 | pages= 215-8 | pmid=10903655 | doi= | pmc=27439 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10903655 }} </ref><ref name="pmid11755299">{{cite journal| author=Banerjee P, Banerjee T, Khand A, Clark AL, Cleland JG| title=Diastolic heart failure: neglected or misdiagnosed? | journal=J Am Coll Cardiol | year= 2002 | volume= 39 | issue= 1 | pages= 138-41 | pmid=11755299 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11755299 }} </ref>. | |||
The diagnosis of diastolic dysfunction or diastolic heart failure is not clinical and requires a work up that goes beyond the history, physical exam, [[echocardiography]] and chest X-rays. Several studies have evaluated the diagnostic criteria to follow in differentiating [[systolic dysfunction]] from [[diastolic dysfunction]]. | |||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
The diagnostic criteria published by the Working Study Group for the European Society of Cardiology in 1998 included three obligatory conditions for the diagnosis of diastolic [[heart failure]]: | The diagnostic criteria published by the Working Study Group for the European Society of Cardiology in 1998 included three obligatory conditions for the diagnosis of diastolic [[heart failure]]: | ||
===Signs or Symptoms of Heart Failure=== | |||
*[[Heart failure]] often presents with a history of [[dyspnea]] and [[orthopnea]], and pulmonary rales on examination. | |||
===Normal or Mildly Abnormal Systolic Left Ventricular (LV) Function=== | |||
*LVEF > 50% and an LV end-diastolic volume index (LVEDVI) <97 mL/m2 | |||
===Evidence of Diastolic LV dysfunction=== | |||
*IVRT: <30 years > 92 ms; 30–50 years > 100 ms; >50 years > 105 msc | |||
*E/A<1 + DT>220 ms + S/D<1.5 <50 years | |||
*E/A<0.5 + DT>280 msec + S/S>2.5 >-50 years<ref>European study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. Eur Heart J 1998;19:990-1003.</ref> | |||
''To note that: DT = deceleration time of E velocity, E/A = ratio of early diastolic velocity to atrial velocity, EF = ejection fraction, HF = heart failure, IVRT = isovolumic relaxation time, LV = left ventricular, LVIDDi = left ventricular internal diastolic diameter index, S/D = ratio of systolic to diastolic velocity of venous pulmonary veins''. | ''To note that: DT = deceleration time of E velocity, E/A = ratio of early diastolic velocity to atrial velocity, EF = ejection fraction, HF = heart failure, IVRT = isovolumic relaxation time, LV = left ventricular, LVIDDi = left ventricular internal diastolic diameter index, S/D = ratio of systolic to diastolic velocity of venous pulmonary veins''. | ||
Other | Other authors have suggested that signs and symptoms of heart failure with a normal ejection fraction is adequate in chronic<ref name="pmid11502702">{{cite journal| author=Zile MR, Gaasch WH, Carroll JD, Feldman MD, Aurigemma GP, Schaer GL et al.| title=Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? | journal=Circulation | year= 2001 | volume= 104 | issue= 7 | pages= 779-82 | pmid=11502702 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11502702 }} </ref> and acute<ref name="pmid11136955">{{cite journal| author=Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM et al.| title=The pathogenesis of acute pulmonary edema associated with hypertension. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 1 | pages= 17-22 | pmid=11136955 | doi=10.1056/NEJM200101043440103 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11136955 }} </ref> heart failure. | ||
==Determining severity== | |||
Echocardiography may grade the severity of diastolic dysfunction, parameters include:<ref name="pmid19187853">{{cite journal| author=Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al.| title=Recommendations for the evaluation of left ventricular diastolic function by echocardiography. | journal=J Am Soc Echocardiogr |year= 2009 | volume= 22 | issue= 2 | pages= 107-33 | pmid=19187853 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&email=rbadgett@kumc.edu.edu&retmode=ref&cmd=prlinks&id=19187853 |doi=10.1016/j.echo.2008.11.023 }}</ref> | |||
* Mild: | |||
** E/A ratio <0.8 | |||
** E/e′ ratio < 8 | |||
* Moderate (grade II; "impaired myocardial relaxation with mild to moderate elevation of LV filling pressures"): | |||
** E/A ratio 0.8 to 1.5 (pseudonormal) | |||
** E/e′ (average) ratio is 9 to 12 | |||
* Severe (grade III; "restrictive LV filling occurs"): | |||
** E/A ratio ≥ 2 | |||
** E/e′ (average) ratio > 13 | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor(s)-in-Chief: Rim Halaby
Overview
The evaluation of the presence of diastolic dysfunction in patients presenting with symptoms of heart failure is of paramount importance.
The accuracy of clinicians to diagnose diastolic dysfunction has been questioned[1][2].
The diagnosis of diastolic dysfunction or diastolic heart failure is not clinical and requires a work up that goes beyond the history, physical exam, echocardiography and chest X-rays. Several studies have evaluated the diagnostic criteria to follow in differentiating systolic dysfunction from diastolic dysfunction.
Diagnostic Criteria
The diagnostic criteria published by the Working Study Group for the European Society of Cardiology in 1998 included three obligatory conditions for the diagnosis of diastolic heart failure:
Signs or Symptoms of Heart Failure
- Heart failure often presents with a history of dyspnea and orthopnea, and pulmonary rales on examination.
Normal or Mildly Abnormal Systolic Left Ventricular (LV) Function
- LVEF > 50% and an LV end-diastolic volume index (LVEDVI) <97 mL/m2
Evidence of Diastolic LV dysfunction
- IVRT: <30 years > 92 ms; 30–50 years > 100 ms; >50 years > 105 msc
- E/A<1 + DT>220 ms + S/D<1.5 <50 years
- E/A<0.5 + DT>280 msec + S/S>2.5 >-50 years[3]
To note that: DT = deceleration time of E velocity, E/A = ratio of early diastolic velocity to atrial velocity, EF = ejection fraction, HF = heart failure, IVRT = isovolumic relaxation time, LV = left ventricular, LVIDDi = left ventricular internal diastolic diameter index, S/D = ratio of systolic to diastolic velocity of venous pulmonary veins.
Other authors have suggested that signs and symptoms of heart failure with a normal ejection fraction is adequate in chronic[4] and acute[5] heart failure.
Determining severity
Echocardiography may grade the severity of diastolic dysfunction, parameters include:[6]
- Mild:
- E/A ratio <0.8
- E/e′ ratio < 8
- Moderate (grade II; "impaired myocardial relaxation with mild to moderate elevation of LV filling pressures"):
- E/A ratio 0.8 to 1.5 (pseudonormal)
- E/e′ (average) ratio is 9 to 12
- Severe (grade III; "restrictive LV filling occurs"):
- E/A ratio ≥ 2
- E/e′ (average) ratio > 13
References
- ↑ Caruana L, Petrie MC, Davie AP, McMurray JJ (2000). "Do patients with suspected heart failure and preserved left ventricular systolic function suffer from "diastolic heart failure" or from misdiagnosis? A prospective descriptive study". BMJ. 321 (7255): 215–8. PMC 27439. PMID 10903655.
- ↑ Banerjee P, Banerjee T, Khand A, Clark AL, Cleland JG (2002). "Diastolic heart failure: neglected or misdiagnosed?". J Am Coll Cardiol. 39 (1): 138–41. PMID 11755299.
- ↑ European study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. Eur Heart J 1998;19:990-1003.
- ↑ Zile MR, Gaasch WH, Carroll JD, Feldman MD, Aurigemma GP, Schaer GL; et al. (2001). "Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure?". Circulation. 104 (7): 779–82. PMID 11502702.
- ↑ Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM; et al. (2001). "The pathogenesis of acute pulmonary edema associated with hypertension". N Engl J Med. 344 (1): 17–22. doi:10.1056/NEJM200101043440103. PMID 11136955.
- ↑ Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA; et al. (2009). "Recommendations for the evaluation of left ventricular diastolic function by echocardiography". J Am Soc Echocardiogr. 22 (2): 107–33. doi:10.1016/j.echo.2008.11.023. PMID 19187853.