Guidelines for assessing diastolic function by echocardiography are continually being updated. Our ability to use available guidelines effectively has not been completely investigated. Six trained echocardiographers were asked to interpret 105 echocardiograms using current American Society of Echocardiography (ASE) algorithms for interpretation of diastolic grade and estimation of left atrial (LA) pressure. Diastolic grade was categorized as normal, mild, moderate, or severe dysfunction. The presence or absence of elevated LA pressure was determined using a second ASE algorithm. As a reference comparison for level of agreement, left ventricular ejection fraction was visually determined. By the ASE algorithm, 29 subjects (28%) met all measurement criteria in their assigned grade and 57 subjects (55%) met all or all but one criterion of their assigned grade. Of the 45 subjects (43%) for whom the guidelines disagreed by more than 1 criterion, the readers debated between normal and moderate dysfunction in 22% or mild and moderate diastolic dysfunction in 31%. Percent inter-reader agreement and kappa values were 76% (0.7) for determining diastolic grade, 84% (0.67) for determining elevated LA pressure, and 84% (0.67) for estimation of ejection fraction, the reference standard. For all subjects, if multiple echocardiographic criteria failed to fit into the proposed guidelines, agreement fell to 66% (0.58) for determining diastolic grade and 74% (0.48) for determining LA pressure. There is reasonable agreement estimating diastolic grade and LA pressure using current guidelines. Further refinements in the definition of mild and moderate dysfunction may improve agreement.
[Show abstract][Hide abstract] ABSTRACT: A hallmark characteristic of heart failure (HF) is reduced physical activity (PA) patterns. The relationship between key cardiopulmonary exercise testing (CPX) variables and PA patterns has not been investigated. Therefore, we evaluated PA patterns in patients with ischemic HF and its relationship to peak oxygen consumption (VO2), the minute ventilation/carbon dioxide production (VE/VCO2) slope, and the oxygen uptake efficiency slope (OUES).
Sixteen patients with HF wore an accelerometer for six days to measure total steps/day as well as percentage of time at light, moderate, and vigorous PA. Symptom-limited CPX was performed on a treadmill using a ramping protocol. Total steps correlated with VO2 (r = 0.64 P < .05), the VE/VCO2 slope (r = -0.72; P < .05), and the OUES (0.63; P < .05). The percentage of time at light-intensity PA correlated with the VE/VCO2 slope (r = 0.58; P < .05) and the OUES (r = -0.51; P < .05). The percentage of time at vigorous-intensity PA correlated with peak VO2 (r = 0.55; P < .05) and the VE/VCO2 slope (r = -0.52; P < .05).
PA assessed by accelerometer is significantly associated with key CPX variables in patients with HF.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: A hallmark characteristic of heart failure (HF) is reduced physical activity (PA) patterns and functional capacity. The relationship between key cardiopulmonary exercise testing (CPX) variables and PA patterns has not been investigated. PURPOSE: To evaluate PA patterns in patients with ischemic HF and its relationship to peak oxygen consumption (VO2), the minute ventilation/dioxide carbon production (VE/VCO2) slope and the oxygen uptake efficiency slope (OUES). METHODS: A cross sectional study was carried out in 16 patients with ischemic HF (age 57 ± 9 years). Subjects wore an accelerometer for six days to measure total steps/day as well as percent time at light, moderate and vigorous PA. A symptom-limited CPX was performed on a treadmill. Oxygen consumption (ml.Kg-1.min-1), VCO2 (L/min) and VE (L/min) were collected throughout the CPX. The VE/VCO2 slope and OUES were obtained by least squares linear regression. One way analysis of variance was used to assess differences between PA patterns at different intensities. Pearson’s correlation was used to assess the relationship between PA and CPX variables. A p-value < 0.05 was considered statistically significant. RESULTS: Subjects performed an average of 9029 steps/day, with the majority of PA performed at light intensity compared to moderate and vigorous intensities ( p < 0.05). PA patterns demonstrated a significant correlation with key CPX variables. Total steps correlated with peak VO2 (r = 0.64 p < 0.05), the VE/VCO2 slope (r = - 0.72; p < 0.05) and the OUES (0.63; p <0.05). The percent time at light intensity PA correlated with the VE/VCO2 slope (r = 0.58; p < 0.05) and the OUES (- 0.51; p <0.05). The percent time at vigorous intensity PA correlated with peak VO2 (r = 0.55; p < 0.05) and the VE/VCO2 slope (r = - 0.52; p < 0.05). CONCLUSION: PA assessed by accelerometer is significantly associated with key CPX variables in patients with HF. These findings suggest PA monitoring may provide insight into functional patterns and identify patients with a higher likelihood for a poor CPX response.
American Thoracic Society International Conference; 05/2014
[Show abstract][Hide abstract] ABSTRACT: To investigate the relationship between cardiac diastolic dysfunction and outcomes in patients with pulmonary arterial hypertension (PAH) and to clarify the potential effect of two-dimensional echocardiography (2D-echo) on prognostic value in patients with PAH.
Patients diagnosed with PAH (as WSPH (World Symposia on Pulmonary Hypertension) classification I) confirmed by right heart catheterization (RHC), received targeted monotherapy or combination therapy. 2D-echo parameters, World Health Organization (WHO) functional classification and 6-minute walking distance (6MWD) were recorded. The clinical prognosis of patients was assessed by the correlation between echo parameters and clinical 6MWD using receiver operating characteristic (ROC) curve analysis.
Fifty-eight patients were included. Left and right ventricular diastolic dysfunction (LVDD and RVDD) scores measured by 2D-echo had good correlation with 6MWD at baseline (rLVDD = -0.699; rRVDD = -0.818, both P<0.001) and at last follow-up (rLVDD = -0.701; rRVDD = -0.666, both P<0.001). Furthermore, bi-ventricular (LVDD+RVDD) scores measured by 2D-echo had a better correlation with 6MWD at baseline and last follow-up (r = -0.831; r = -0.771, both P<0.001). ROC curve analysis showed that the area under curves (AUCs) for LVDD score, RVDD score and (LVDD+RVDD) scores were 0.823 (P<0.0001), 0.737 (P = 0.0002), and 0.825 (P<0.0001), respectively. Compared with ROC analysis of other single parameters, cardiac diastolic function score was more accurate in predicting survival in patients with PAH.
LVDD score, RVDD score and (LVDD+RVDD) scores yielded a comprehensive quantitative assessment of LV and RV diastolic function that correlated moderately with clinical functional parameters and might be useful in the assessment of PAH.
PLoS ONE 12/2014; 9(12):e114443. DOI:10.1371/journal.pone.0114443 · 3.23 Impact Factor
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