Investigating the European Society of Cardiology Diastology Guidelines in a practical scenario

Aims Recently, the European Society of Cardiology (ESC) released a consensus statement for the diagnosis of heart failure with preserved ejection fraction (HFPEF). It state that E/e > 15 or <8 clearly define those with or without HFPEF and that for those in the range 8-15, other parameters should be examined. Methods and results We retrospectively analysed 1229 consecutive echocardiograms (57% mates) for the utility of echocardiographic measures including left atrial. volume index (LAVI), left ventricular mass index (LVMI), and pulmonary venous and mitral inflow Doppler. LAVI of 40 ml/m(2) provided the greatest sensitivity and specificity of 76 and 77%, respectively, with reference to E/e' for the detection of diastolic dysfunction. The ESC definition of raised LVMI yielded a sensitivity and specificity of 32 and 99%, respectively. We found that the mitral and pulmonary inflow provided little incremental information. These results remained consistent between those with normal and abnormal ejection fraction. Conclusions There appears to be little incremental value of pulmonary and mitral Doppler measures beyond the measure of mitral. E wave. An LAVI cut-off of 40 ml/m(2) maximizes both sensitivity and specificity. However, ESC guidelines of raised LVMI in patients with HFPEF would appear to heavily trade sensitivity for specificity.