Resting E/e' was significantly associated with occult diastolic dysfunction after fluid challenge in both retrospective (OR 1.9; 95% CI 1.1-3) and prospective (OR 8.75; 95% CI 2.3-33) cohorts.
Cohort (n=178)
Are echocardiographic measures of diastolic function associated with occult diastolic dysfunction identified at right heart catheterization with fluid challenge?
Routine echocardiographic measurements, specifically E velocity and E/e', can help non-invasively identify patients likely to have occult diastolic dysfunction during fluid challenge.
Odds Ratio: 1.9 (95% CI 1.1–3)
p-value: p=0.005
Background Identification of occult diastolic dysfunction often requires invasive right heart catheterization with provocative maneuvers such as fluid challenge. Non-invasive predictors of occult diastolic dysfunction have not been identified. We hypothesized that echocardiographic measures of diastolic function are associated with occult diastolic dysfunction identified at catheterization. Methods and Results We retrospectively examined hemodynamic and echocardiographic data from consecutive patients referred for right heart catheterization with fluid challenge from 2009 to 2017. A replication cohort of 52 patients who prospectively underwent simultaneous echocardiography and right heart catheterization before and after fluid challenge at Monaldi Hospital, Naples, Italy. In the retrospective cohort of 126 patients (83% female, 56+14 years), 27/126 (21%) had occult diastolic dysfunction. After adjusting for tricuspid regurgitant velocity and left atrial volume index, E velocity (odds ratio 1.8, 95% CI 1.1-2.9, P=0.01) and E/e' (odds ratio 1.9, 95% CI 1.1-3, P=0.005) were associated with occult diastolic dysfunction with an optimal threshold of E/e' >8.6 for occult diastolic dysfunction (sensitivity 70%, specificity 64%). In the prospective cohort, 5/52 (10%) patients had diastolic dysfunction after fluid challenge. Resting E/e' (odds ratio 8.75, 95% CI 2.3-33, P=0.001) and E velocity (odds ratio 7.7, 95% CI 2-29, P=0.003) remained associated with occult diastolic dysfunction with optimal threshold of E/e' >8 (sensitivity 73%, specificity 90%). Conclusions Among patients referred for right heart catheterization with fluid challenge, E velocity and E/e' are associated with occult diastolic dysfunction after fluid challenge. These findings suggest that routine echocardiographic measurements may help identify patients like to have occult diastolic dysfunction non-invasively.
Agrawal et al. (Sat,) conducted a cohort in Occult diastolic dysfunction in pulmonary hypertension (n=178). Echocardiographic measures of diastolic function (E velocity and E/e') was evaluated on Occult diastolic dysfunction after fluid challenge (OR 1.9, 95% CI 1.1-3, p=0.005). Resting E/e' was significantly associated with occult diastolic dysfunction after fluid challenge in both retrospective (OR 1.9; 95% CI 1.1-3) and prospective (OR 8.75; 95% CI 2.3-33) cohorts.