P653EAE/ASE guidelines for evaluation of left ventricular diastolic dysfunction in clinical practice

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Purpose: Diastolic dysfunction is found in approximately 40 % of patients after an AMI, and is known to increases morbidity and mortality. Recently EAE/ESC has suggested new criteria for identification of increased filling pressure based on diastolic E/e' and left atrial (LA) volume in patients with preserved systolic function. In the present study pulmonary capillary wedge pressure (PCWP) was assessed at rest and during exercise in patients with a recent AMI and filling pattern suggestive of increased filling pressure according to EAE/ASE guidelines and in a healthy control group with no signs of increased filling pressure.Methods: Thirty three patients (age 62 ± 8, 83 % male) with revascularized AMI and LVEF> 45 %, E/e' 8-15 and LA > 34 ml/m2, underwent a symptom limited supine bicycle test with simultaneous right heart catheterization and echocardiography. Ten healthy controls (age 47 ± 5, 80 % male) were also included. Hemodynamic parameters were measured at rest and peak exercise. A PCWP > 12 mmHg at rest and > 25 mmHg during exercise was considered abnormal.Results: Resting values, patients and controls, respectively were, LVEF 54 ± 6 % vs LVEF 63 ± 3 % (P<0.001), E/e' 10.9 ± 2.8 vs 6.3 ± 2.3 (p<0.001), LA indexed 43.4 ± 11.6 ml/m2 vs 29.7± 7.9ml/m2 (p<0.001) and PCWP 13.6 ± 4.3 mmHg vs 8.9 ± 1.9 mmHg (p<0.004). At rest none of the healthy controls and 19 (54%) of the patients had elevated PCWP. At peak exercise none of the healthy but 31 (94 %) of the patients had elevated PCWP.Conclusion: This study shows that although EAE/ESC guidelines only identifies patients with invasively measured increased filling pressure at rest with moderate accuracy, the vast majority of the patients identified by the guidelines are characterized by abnormal filling pressure during exercise.

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