Application of the 2016 ase-eacvi criteria for the assessment of diastolic function in arterial hypertension

Abstract Background No data are available on diagnostic algorithms recommended by guidelines for the assessment of diastolic dysfunction (DD) in patients with arterial hypertension. Purpose To fill this gap, we evaluated left ventricular (LV) diastolic function in hypertensive patients matched with healthy subjects. Methods Healthy subjects, hypertensive patients without and with LV hypertrophy (LVH) were matched 1:1:1 based on age, sex, and body mass index from two prospective registries. All participants had normal LV ejection fraction (EF). Diastolic function was assessed basing on 2016 ASE-EACVI guidelines, by applying algorithm A, recommended in normal LVEF, and algorithm B recommended in reduced LVEF or normal LVEF and myocardial disease. Results A total of 717 participants were enrolled. By applying algorithm A, an indeterminate pattern was found in 0.4% of healthy subjects, in 6.3% of hypertensive patients without LVH (p=0.015 vs. healthy subjects), and in 21% of hypertensive patients with LVH (p=0.001 vs. healthy subjects). DD was absent in healthy individuals, whereas it was found in 2% and 8% of hypertensives without (p=0.06) and with LVH (p=0.001 vs. healthy subjects), respectively. By applying algorithm B, no cases of indeterminate diastolic function were found. DD was observed in 2.9% of healthy subjects, 7% and 10.5% of hypertensives without (p=0.001 vs. healthy subjects) and with LVH (p=0.002 vs. healthy subjects). Conclusion When diastolic function is assessed by echocardiography, the use of algorithm A should be limited only to truly normal subjects, whereas algorithm B should be applied to all patients with hypertension irrespective of LVH