Echocardiography vs Hemodynamic Assessment of Diastolic Dysfunction

Objectives. Diagnosing diastolic dysfunction (DD) is complex and controversial. The American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) criteria for diagnosing DD are widely accepted in clinical practice. The study's aim was to evaluate the added value of invasive hemodynamic assessment in patients with unexplained shortness of breath (SOB) undergoing echocardiographic assessment using the most accepted echocardiographic definition of DD. Methods. A retrospective cohort study included 91 consecutive patients with preserved left-ventricular function who underwent right-heart catheterization with moderate-intensity exercise to evaluate unexplained SOB. Patients were divided into 2 groups: Group 1 without DD (33 patients with resting pulmonary capillary wedge pressure [PCWP] <= 15 mm Hg and exercise PCWP < 18), and Group 2 with DD (58 patients with resting PCWP > 15 mm Hg and/or exercise PCWP >= 18). Of Group 2, 48 (53%) had a resting PCWP >15 mm Hg and 10 (11%) had exercise-induced PCWP >= 18 mm Hg. Results. Echocardiographic criteria for DD were compared with invasive PCWP. Mean age was 62 +/- 17 years, 66% were women. The ASE/EACVI echocardiographic criteria were positive for DD (3-4/4 criteria) in 12.1% of Group 1 patients and 46.6% of Group 2 patients. Approximately one-half of the patients without echocardiographic evidence (0-1/4 criteria) or with indeterminate echocardiographic findings (2/4 criteria) had invasively proven DD (48.4% and 55.2%, respectively). In patients with echocardiographic evidence of DD (3-4/4 criteria), invasively proven DD was present in 87.1%. Conclusions: Echocardiographic assessment is insufficiently sensitive for the diagnosis of DD. Invasive hemodynamic assessment can refine the diagnosis of DD in patients with unexplained SOB.