Prevalence of left ventricular diastolic dysfunction by Doppler echocardiography: Clinical application of the Canadian consensus guidelines

doi:10.1067/mje.2002.124877

Journal of the American Society of Echocardiography

Volume 15, Issue 10, Part 2, October 2002, Pages 1238-1244

https://doi.org/10.1067/mje.2002.124877 Get rights and content

Abstract

We evaluated diastolic filling patterns using Doppler echocardiography in 520 consecutive patients referred to our laboratory for transthoracic echocardiograms retrospectively and applied the standard guidelines used to characterize left ventricular (LV) diastolic function. Patients were classified by the Canadian consensus guidelines using transmitral and pulmonary venous Doppler echocardiographic parameters to have normal diastolic function or mild (abnormal relaxation), mild-to-moderate, moderate (pseudonormal), or severe (restrictive) diastolic dysfunction. LV diastolic dysfunction was present in 290 (56%) patients, whereas 167 (45%) patients with a normal LV ejection fraction had abnormal diastolic function. Patients with progressively more abnormal diastolic patterns had greater structural abnormalities with larger left atrial and LV size and lower LV ejection fractions. In the subset of patients with clinical evidence of congestive heart failure (99 patients), the prevalence of primary diastolic heart failure was 38% and most patients had underlying coronary or hypertensive heart disease. Standard guidelines of Doppler echocardiographic parameters allow semiquantitation of diastolic function and can be applied to studying large number of patients in a large clinical practice. (J Am Soc Echocardiogr 2002;15:1237-44.)

Section snippets

Study population

All data was evaluated retrospectively. The study group consisted of 520 consecutive patients referred to our laboratory for transthoracic echocardiographic examinations. Patients with severe mitral regurgitation, mitral stenosis, mitral valve prosthesis or repair, pericardial tamponade, and constriction were excluded because unique hemodynamics in those patients affect the transmitral and pulmonary venous flow patterns. Likewise, patients with atrial fibrillation, rapid heart rate (>120 bpm),

Results

The mean age of patients was 62 ± 15 years with a range of 20 to 92 years. There were 326 men (63%) and 194 women (37%). The reasons for referral for the echocardiogram included coronary artery disease (27%); valvular disease (26%); heart failure (25%); hypertension (8%); and other miscellaneous indications (14%). The transmitral flow velocity pattern was recorded in all patients and an interpretable complete profile (including systolic, diastolic, and atrial reversal waves of pulmonary venous

Discussion

The noninvasive echocardiographic assessment of LV diastolic function has been attempted using Doppler echocardiographic indices of transmitral and pulmonary venous flow.5, 6, 7, 8, 9 These patterns have been used not only for diagnostic purposes but also for establishing prognosis and evaluating the effect of therapeutic interventions.19, 20, 21, 22 There is an increasing desire to measure echocardiographic indices of LV diastolic function routinely in conditions in which it can affect patient

Conclusion

LV diastolic dysfunction was present in 56% of 520 patients who were referred to transthoracic echocardiography using the Canadian consensus guidelines. In these patients, mild and moderate dysfunction were equally common and mild-to-moderate dysfunction was least common. Using these standard criteria, characterization of Doppler echocardiographic parameters of transmitral flow and pulmonary venous flow velocity pattern allows semiquantification of diastolic dysfunction. This integrated

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^☆: Reprint requests: Allan L. Klein, MD, the Cleveland Clinic Foundation, Department of Cardiovascular Medicine/F15, 9500 Euclid Ave, Cleveland, OH 44195 (E-mail: [email protected]).

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Original ArticlesPrevalence of left ventricular diastolic dysfunction by Doppler echocardiography: Clinical application of the Canadian consensus guidelines☆

Abstract

Section snippets

Study population

Results

Discussion

Conclusion

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

Am J Cardiol

J Am Soc Echocardiogr

Mayo Clin Proc

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Original Articles
Prevalence of left ventricular diastolic dysfunction by Doppler echocardiography: Clinical application of the Canadian consensus guidelines☆