Diastolic Dysfunction Assessed Using Contemporary Guidelines and Prognosis Following Myocardial Infarction
CME Information: 1.00 credits
Release date: Oct 2018 Valid through: Oct 2019
Introduction/Statement of Need:
Recent American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines for the assessment of diastolic dysfunction (DD) recommend a simplified approach with four key variables incorporated into a novel diagnostic algorithm. The aim of this study was to assess the prognostic value of significant DD assessed using the algorithm recommended in the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines (DD2016) in comparison with the prognostic value of significant DD assessed using the 2009 guidelines (DD2009) as well as the individual parameters incorporated in the 2016 algorithm.
This activity is designed for all cardiac sonographers and cardiovascular physicians with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, intensivists, and other medical professionals.
At the end of this article the reader will better be able to:
Identify the four key variables incorporated into the 2016 diagnostic algorithm to assess diastolic function
Appreciate the prognostic value of these variables in patients following myocardial infarction
Compare aggregate assessment of diastolic dysfunction using algorithms from 2016 with the prognostic value of any individual parameter incorporated in the algorithm
The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The American Society of Echocardiography designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn 1.00 MOC point in the American Board of Internal Medicine's (ABIM). Participants will earn MOC point’s equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
ARDMS, CCI and Sonography Canada recognize ASE’s certificates and have agreed to honor the credit hours toward their registry requirements for sonographers.
The American Society of Echocardiography is committed to ensuring that its educational mission and all sponsored educational programs are not influenced by the special interests of any corporation or individual, and its mandate is to retain only those authors whose financial interests can be effectively resolved to maintain the goals and educational integrity of the activity. While a monetary or professional affiliation with a corporation does not necessarily influence an author’s presentation, the Essential Areas and policies of the ACCME require that any relationships that could possibly conflict with the educational value of the activity be resolved prior to publication and disclosed to the audience. Disclosures of faculty and commercial support relationships, if any, have been indicated.
Sandhir B. Prasad, MBBS, FRACP, Andrew K. Lin, MBBS, BMedSci, FRACP, Kristyan B. Guppy-Coles, BAppSc, BSc (Hons), PhD, Tony Stanton, MBChB, PhD, FRACP, Rathika Krishnasamy, MBBS, PhD, FRACP, Gillian A. Whalley, BSc, PhD, Liza Thomas, MBBS, PhD, FRACP, and John J. Atherton, MBBS, PhD, FRACP, Brisbane, Birtinya, and Sydney, Australia; and Auckland, New Zealand.
According to ACCME policy, ASE implemented mechanisms to resolve all conflicts of interest prior to the planning and implementation of this activity.
The following author(s) reports actual or potential conflicts of interest in relation to this document:
The following authors reported no actual or potential conflicts of interest in relation to this document:
Sandhir Prasad, MBBS, FRACP, FCSANZ, Rathika Krishnasamy, MBBS, PhD, Andrew Lin, MBBS, MMedSci, FRACP, Kristyan Guppy-Coles, BAppSc, Bsc (Hons), PhD, Gillian Whalley, PhD, FASE, Tony Stanton, BBChB, PhD and John James Atherton, MBBS, PhD, FRACP, FCSANZ, FESC.
The following ACCME reviewers, ASE Staff and CME editors reported no actual or potential conflicts of interest in relation to this document:
Priscilla Peters, and Christina LaFuria
The following ACCME reviewers, ASE Staff and CME editors reported relationships with one or more commercial interests:
Method of Participation: Online Only
Estimated Time to Complete this Activity: 1 hour
Receiving CME Credit:
To receive online CME credit for this activity, read the full activity then complete the posttest and evaluation. A score of 70% or higher is required for successful completion. You will be able to print your CME certificate immediately following successful completion of the posttest and evaluation.
You will need a compatible browser like Mozilla FireFox, Google Chrome or safari to view the content. Internet Explorer may not work.
This report is made available by ASE as a courtesy reference source for members. This report contains recommendations only and should not be used as the sole basis to make medical practice decisions or for disciplinary action against any employee. The statements and recommendations contained in this report are primarily based on the opinions of experts, rather than on scientifically verified data. ASE makes no express or implied warranties regarding the completeness or accuracy of the information in this report, including the warranty of merchantability or fitness for a particular purpose. In no event shall ASE be liable to you, your patients, or any other third parties for any decision made or action taken by you or such other parties in reliance on this information. Nor does your use of this information constitute the offering of medical advice by ASE or create any physician patient relationship between ASE and your patients or anyone else.
Copyright American Society of Echocardiography. Questions? Contact us at email@example.com
1. Møller JE, Whalley GA, Dini FL, Doughty RN, Gamble GD, Klein AL, et al. Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: meta-Analysis Research Group in Echocardiography Acute Myocardial Infarction. Circulation 2008;117:2591-8. 2. Møller JE, Pellikka PA, Hillis GS, Oh JK. Prognostic importance of diastolic function and filling pressure in patients with acute myocardial infarction. Circulation 2006;114:438-44. 3. Møller JE, Sondergaard E, Seward JB, Appleton CP, Egstrup K. Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction: prognostic and clinical implications. J Am Coll Cardiol 2000;35:363-70. 4. Cerisano G, Bolognese L, Buonamici P, Valenti R, Carrabba N, Dovellini V, et al. Prognostic implications of restrictive left ventricular filling in reper- fused anterior acute myocardial infarction. J Am Coll Cardiol 2001;37: 793-9. 5. Møller JE, Egstrup K, Kober L, Poulsen SH, Nyvad O, Torp-Pedersen C. Prognostic importance of systolic and diastolic function after acute myocardial infarction. Am Heart J 2003;145:147-53. 6. Nijland F, Kamp O, Karreman AJ, van Eenige MJ, Visser CA. Prognostic implications of restrictive left ventricular filling in acute myocardial infarc- tion: a serial Doppler echocardiographic study. J Am Coll Cardiol 1997; 30:1618-24. 7. Whalley GA, Gamble GD, Dini FL, Klein AL, Møller JE, Quintana M, et al. Individual patient meta-analyses of restrictive diastolic filling pattern and mortality in patients post acute myocardial infarction and in patients with chronic heart failure. Meta-Analysis Research Group in Echocardiog- raphy (MeRGE) collaborators. Int J Cardiol 2007;122:207-15. 8. Hillis GS, Moller JE, Pellikka PA, Gersh BJ, Wright RS, Ommen SR, et al. Noninvasive estimation of left ventricular filling pressure by E/e0 is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol 2004;43:360-7. 9. Møller JE, Søndergaard E, Poulsen SH, Egstrup K. Pseudonormal and restrictive filling patterns predict left ventricular dilation and cardiac death after a first myocardial infarction: a serial color M-mode Doppler echocar- diographic study. J Am Coll Cardiol 2000;36:1841-6.
10. Somaratne JB, Whalley GA, Poppe KK, Gamble GD, Doughty RN. Pseu- donormal mitral filling is associated with similarly poor prognosis as restric- tive filling in patients with heart failure and coronary heart disease: a systematic review and meta-analysis of prospective studies. J Am Soc Echocardiogr 2009;22:494-8. 11. Møller JE, Hillis GS, Oh JK, Seward JB, Reeder GS, Wright RS, et al. Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation 2003;107:2207-12. 12. Beinart R, Boyko V, Schwammenthal E, Kuperstein R, Sagie A, Hod H, et al. Long-term prognostic significance of left atrial volume in acute myocardial infarction. J Am Coll Cardiol 2004;44:327-34. 13. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic func- tion by echocardiography. J Am Soc Echocardiogr 2009;22:107-33. 14. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF III, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American So- ciety of Echocardiography and the European Association of Cardiovascu- lar Imaging. J Am Soc Echocardiogr 2016;29:277-314. 15. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiogra- phy in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echo- cardiogr 2015;28:1-39.e14. 16. Andersen OS, Smiseth OA, Dokainish H, Abudiab MM, Schutt RC, Kumar A, et al. Estimating left ventricular filling pressure by echocardiog- raphy. J Am Coll Cardiol 2017;69:1937-48. 17. Balaney B, Medvedofsky D, Mediratta A, Singh A, Ciszek B, Kruse E, et al. Invasive validation of the echocardiographic assessment of left ven- tricular filling pressures using the 2016 diastolic guidelines: head-to-head comparison with the 2009 guidelines. J Am Soc Echocardiogr 2018;31: 79-88. 18. Lancellotti P, Galderisi M, Edvardsen T, Donal E, Goliasch G, Cardim N, et al. Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. Eur Heart J Cardiovasc Imag- ing 2017;18:961-8. 19. Temporelli PL, Giannuzzi P, Nicolosi GL, Latini R, Franzosi MG, Gentile F, et al. Doppler-derived mitral deceleration time as a strong prognostic marker of left ventricular remodeling and survival after acute myocardial infarction: results of the GISSI-3 echo substudy. J Am Coll Cardiol 2004;43:1646-53. 20. Cerisano G, Bolognese L, Carrabba N, Buonamici P, Santoro GM, Antoniucci D, et al. Doppler-derived mitral deceleration time: an early strong predictor of left ventricular remodeling after reperfused anterior acute myocardial infarction. Circulation 1999;99:230-6. 21. Giannuzzi P, Imparato A, Temporelli PL, de Vito F, Silva PL, Scapellato F, et al. Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. J Am Coll Cardiol 1994;23: 1630-7. 22. Yong Y, Nagueh SF, Shimoni S, Shan K, He ZX, Reardon MJ, et al. Decel- eration time in ischemic cardiomyopathy: relation to echocardiographic and scintigraphic indices of myocardial viability and functional recovery after revascularization. Circulation 2001;103:1232-7. 23. Tsang TS, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol 2006;47:1018-23. 24. Ersboll M, Andersen MJ, Valeur N, Mogensen UM, Fakhri Y, Thune JJ, et al. Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction: a two-dimensional speckle- tracking study. Eur Heart J 2014;35:648-56. 25. Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging 2009;2:356-64.