Invasive Validation of the Echocardiographic Assessment of Left Ventricular Diastology Postacute Coronary Syndrome

ABSTRACT 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.