Relationship of left ventricular and atrial dimensions with moderate to severe left ventricular diastolic dysfunction (grade II and above).

Muhammad Hamza,Maha Nadir,Hafiz Umar Masood,Zubair Satti,Mishal Fatima,Ghazal Tasleem,Muhammad Masood,Hassaan Ahmed

doi:10.4314/ahs.v20i4.27

Abstract

Left ventricular diastolic dysfunction (DD) is an entity in which the ventricle fails to fill up properly due to impaired ventricular relaxation and/or decreased compliance. The diagnosis of diastolic dysfunction is based on a variety of parameters in doppler echocardiograpy. However, some parameters like interventricular septal thickness in diastole (IVSd), posterior wall thickness in diastole (PWd), left ventricular internal end diastolic and systolic diameters (LVIDD and LVISD) along with left atrial diameters (LAD) have yet to be evaluated for the diagnostic workup of DD. A case control study was done in the cardiology department from patient records from 2016 to 2018. Patients were diagnosed as diastolic dysfunction grade II and above by doppler echocardiography. IVSd, PWd, LVIDD, LAD, LVISD were obtained through 2-D echocardiography. Patients with DD had greater LAD, IVSd and PWd and decreased LVIDD and LVISD as compared to control group. Overall, IVSD was the most significant predictor (OR 1.52 95%CI 1.35-1.71) of DD followed by PWd and LAD. Similarly, LAD, IVSd and PWd had higher sensitivity and specificity than LVIDD and LVIDS. IVSd, LAD and PWd showed significant performance in the diagnosis of diastolic dysfunction and hence can be used as a screening and diagnostic tool in diastolic dysfunction of grade ll and above.

Highlights

Left ventricular diastolic dysfunction (DD) is an entity in which the ventricle fails to fill up properly due to impaired ventricular relaxation and/or decreased compliance
In patients with reduced ejection fraction (EF) or patients with preserved EF and myocardial disease (e.g. Coronay Artery Disease) diastolic dysfunction grade II was diagnosed when E/A ratios were either less than or equal to 0.8 with Mitral E velocities greater than 50 cm/sec or when E/A ratios were between 0.8 and 2 along with these two abnormal variables (E/e’ greater than 14 and LA volume index greater than 34mL/m2)
Tricuspid regurgitation (TR) velocities were not acquired for the assessment of diastolic dysfunction and an approach consisting of only E/e’, E/A, LA volume index and mitral annular velocities was utilized as per American Society of Echocardiographic guidelines 2016 when TR velocities are not available[2 178] cases were randomly selected and compared with 191 controls after careful matching for age, sex, hypertension, diabetes

Summary

Introduction

Left ventricular diastolic dysfunction (DD) is an entity in which the ventricle fails to fill up properly due to impaired ventricular relaxation and/or decreased compliance. Conclusion: IVSd, LAD and PWd showed significant performance in the diagnosis of diastolic dysfunction and can be used as a screening and diagnostic tool in diastolic dysfunction of grade ll and above. Left ventricular geometrical indices have been mainly confined to theoretical concept of DD and little work has been done on their application in clinical diagnosis. These indices can be assessed using echocardiography and can provide additional tools in the multi modal diagnostic arsenal available for DD. This study aims to evaluate left ventricular geometrical indices in the screening and diagnosis of DD grade II and above

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