wileyonlinelibrary.com/journal/echo Echocardiography. 2018;35:792–797.
© 2018 Wiley Periodicals, Inc.
Clinical and echocardiographic characteristics of patients
in sinus rhythm, normal left ventricular function, and
indeterminate diastolic function
Matan Shimron BSc
| Lynne Williams PhD, MB, BCh
| Yevgeni Hazanov MD
| Wadia Kinany MD
| Offer Amir MD, FACC
| Shemy Carasso MD
Department of Cardiology, B Padeh
Medical Center, Poriya, Israel
Faculty of Medicine in the Galilee, Bar-Ilan
University, Zefat, Israel
Department of Cardiology, Papworth
Hospital NHS Foundation Trust, Cambridge,
Shemy Carasso, Non-invasive Cardiac
Imaging, Cardiovascular Institute, Padeh
Medical Center, Poriya, Lower Galilee, Israel;
The Faculty of Medicine in the Galilee, Bar-
Ilan University, Safed, Israel.
Background: Diastolic dysfunction (DDFx) is the major underlying mechanism of
heart failure with preserved left ventricular ejection fraction (EF). Yet, the echocar-
diographic diagnosis of DDFx in patients in sinus rhythm is challenging and up to 25%
of studies have discrepant measures making assessment of DDFx indeterminate. We
aimed to describe the clinical and echocardiographic characteristics of patients with
indeterminate diastolic function compared to patients with definite normal and ab-
normal diastolic function.
Methods: One thousand six hundred seventy-four patients were identified from
the echocardiography database in sinus rhythm, EF ≥ 45% without wall- motion
abnormalities, valvular, congenital heart diseases, cardiomyopathies or pulmo-
nary disease. Patients were divided according to their lateral mitral E/Eʹ ratio
and left atrial systolic diameter: normal diastolic function (DFx) (left atrial sys-
tolic diameter [LASd] <40 mm, E/Eʹ < 10), DDFx (LASd ≥ 40 mm, E/Eʹ ≥ 10) and
indeterminate DFx (discrepant LASd diameter and E/Eʹ ratio).
Results: Clinical and echocardiographic characteristics of the 3 groups, DDFx
(n = 186), indeterminate diastolic function (IndtDFx) (n = 207), and normal diastolic
function (NDFx) (n = 1281) were significantly different. IndtDFx demonstrated inter-
mediate parameter abnormalities, largely overlapping with DDFx. LASd and E/Eʹ
were similarly associated with the inability to determine diastolic function. Age, fe-
male gender, renal failure, E/Eʹ and pulmonary pressure were found to be independ-
ent predictors of heart failure symptoms (RR = 1.02, 1.5, 2.5, 1.1, 1.1, respectively,
P < .0001, r = .35).
Conclusion: Clinically and echocardiographically patients with IndtDFx are more
closely related to DDfx than to NDFx. Although LAd was abnormal in IndtDFx it was
not predictive of heart failure symptoms. Further study is suggested to establish
whether LA function rather than its maximal size can provide additional
cardiac function, echocardiography, heart failure