Evolution of diastolic function algorithms: Implications for clinical practice.

Objective: We undertook this study of echocardiographic classification of diastolic function by three different algorithms to determine: (1) how frequently each algorithm classified patients and (2) how well the results agreed with one another. Background: Several algorithms exist to grade diastolic...

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Published in:Echocardiography Vol. 35; no. 1; pp. 39 - 47
Main Authors: Gottbrecht, Matthew F., Salerno, Michael, Aurigemma, Gerard P.
Format: research tables/charts Journal Article
Published: Wiley-Blackwell Jan2018
Online Access:View this record in EBSCOhost
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      dt: Jan2018
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      pub: Wiley-Blackwell
      place: Malden, Massachusetts
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        127390645
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        10.1111/echo.13746
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      tig:
        atl: Evolution of diastolic function algorithms: Implications for clinical practice.
      aug:
        au:
          Gottbrecht, Matthew F.
          Salerno, Michael
          Aurigemma, Gerard P.
        affil: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
      sug:
        subj:
          Algorithms
          Diastolic Pressure
          Echocardiography
          Human
          Calcinosis
          Practice Guidelines
          Middle Age
          Aged
          Male
          Female
          kappa Statistic
          Middle Aged: 45-64 years
          Aged: 65+ years
          Male
          Female
      ab: Objective: We undertook this study of echocardiographic classification of diastolic function by three different algorithms to determine: (1) how frequently each algorithm classified patients and (2) how well the results agreed with one another. Background: Several algorithms exist to grade diastolic function (DF), the Mayo Clinic scheme of Redfield et al (Mayo 2003) and the 2 ASE guideline documents of 2009 and 2016 (ASE 2009 and ASE 2016). Methods: A total of 200 consecutive echocardiograms were retrospectively analyzed; mean age of patients 60.3 ± 3.5 years, 45% male. Echocardiograms were performed using Intersocietal Accreditation Commission guidelines. Diastolic function was assessed by Mayo 2003 and ASE 2009 and 2016. Coexisting conditions affecting DF analysis, such as mitral annular calcification (MAC), were tabulated. Data were compared using a paired <italic>t</italic>‐test. Concordance between algorithms was assessed using the Kappa statistic. Results: A total of 117 of 200 studies (58.5%) were excluded for the presence of coexisting conditions (51.5%), poor image quality (2.5%), or incomplete data (4.5%). Thirty‐three of the remaining 83 studies (40%) received the same grade of DF based on assessments made using the Mayo 2003 and ASE 2016 algorithms; the Kappa statistic was 0.20. 36 of the 83 studies (43%) received the same grade of DF based on assessments made using the ASE 2009 and ASE 2016 algorithms; the Kappa statistic was 0.25. Conclusion: Assessment of diastolic function via echocardiography cannot be reliably accomplished in approximately 50% of patients using current guidelines. Further, when studies are suitable for assessment, widely used guidelines yield discordant results.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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