Key result
The 2016 ASE/EACVI guidelines show weak agreement with invasive measurements in high-risk ACS patients.
Why the study?
The 2016 ASE/EACVI diastolic dysfunction guidelines were validated in stable patients, leaving their performance and ease of implementation unclear in high-risk ACS.
Does the 2016 ASE/EACVI guideline algorithm accurately estimate left ventricular filling pressures compared to invasive measurements in patients with high-risk ACS?
Observational (n=101)
Blinded
Does the 2016 ASE/EACVI guideline algorithm accurately estimate left ventricular filling pressures compared to invasive measurements in patients with high-risk ACS?
The 2016 ASE/EACVI diastolic dysfunction guidelines demonstrate weak to intermediate sensitivity but good specificity for noninvasively estimating left ventricular filling pressures in high-risk ACS patients.
Clinicians should interpret 2016 ASE/EACVI estimates cautiously in high-risk ACS; leaves open need for ACS-specific validation against invasive pressures.
Background Diastolic dysfunction (DD) is a negative predictor in acute coronary syndrome (ACS). The 2016 American Society of Echocardiography (ASE) and the European Association of Cardiac Imaging (EACVI) DD guidelines (2016 ASE/EACVI guidelines) were validated in stable patients. We assessed the effect of implementing the 2016 ASE/EACVI guidelines in a population of patients with high‐risk ACS by correlating invasively measured left ventricular diastolic pressures or pulmonary capillary wedge pressure (PCWP) within 8 h of the echocardiography estimated left ventricle (LV) filling pressures and determined how easily general cardiologists could apply the 2016 ASE/EACVI guideline parameters to see if this affects accuracy. Methods Two groups of independent investigators, group FT, full‐time (FT) echocardiography consultants, and group PT, part‐time (PT) board‐certified general cardiologists, blinded to each other and the invasive LV measurements, reviewed digitally stored echocardiography images. The researchers applied the 2016 DD guidelines definitions to 101 (24% females, mean age 57.2 ± 12.5, and a mean BSA 1.8 ± 0.2) high‐risk ACS troponin I‐positive patients admitted to the coronary care unit between December 2007 and February 2018. DD grade assessment using 2009 guidelines was obtained from the echocardiography reports. Results The 2009 ASE/EACVI guideline results showed 0.58 sensitivity and 0.74 specificity. The 2016 ASE/EACVI guidelines in the FT group had 0.46 sensitivity and 0.74 specificity, and in the PT group, 0.45 sensitivity and 0.86 specificity. Conclusions The agreement with 2016 ASE/EACVI guideline definitions in high‐risk ACS patients was weak to intermediate. The 2016 ASE/EACVI guidelines classification and the noninvasive left ventricular filling pressure assessment were easy to implement compared to the 2009 ASE/EACVI guidelines. Our study validates the 2016 ASE/EACVI guideline algorithm in patients with high‐risk ACS.
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Elsherif et al. (2025) conducted an observational in high-risk acute coronary syndrome (n=101). 2016 ASE/EACVI diastolic dysfunction guidelines vs. 2009 ASE/EACVI guidelines was evaluated on Agreement with invasively measured left ventricular diastolic pressures or pulmonary capillary wedge pressure. The 2016 ASE/EACVI guidelines showed weak to intermediate agreement with invasive measurements in high-risk ACS patients, yielding 0.45-0.46 sensitivity and 0.74-0.86 specificity.
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