The American Society for Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) 2016 guidelines for assessment of diastolic dysfunction (DD) are based primarily on the effects of diastolic dysfunction on left ventricular filling hemodynamics. However, these measures do not provide quantifiable mechanistic information about diastolic function. The Parameterized Diastolic Filling (PDF) formalism is a validated theoretical framework that describes DD in terms of the physical properties of left ventricular filling. We hypothesized that PDF analysis can provide mechanistic insight into the mechanical properties governing higher grade DD. Patients referred for echocardiography showing reduced left ventricular ejection fraction (< 45%) were prospectively classified into DD grade according to 2016 ASE/EACVI guidelines. Serial E-waves acquired during free breathing using pulsed wave Doppler of transmitral blood flow were analyzed using the PDF formalism. Higher DD grade (grade 2 or 3, n = 20 vs grade 1, n = 30) was associated with increased chamber stiffness (261 ± 71 vs 169 ± 61 g/s2, p < 0.001), increased filling energy (2.0 ± 0.9 vs 1.0 ± 0.5 mJ, p < 0.001) and greater peak forces resisting filling (median [interquartile range], 18 [15–24] vs 11 [8–14] mN, p < 0.001). DD grade was unrelated to chamber viscoelasticity (21 ± 4 vs 20 ± 6 g/s, p = 0.32). Stiffness was inversely correlated with ejection fraction (r = − 0.39, p = 0.005). Higher grade DD was associated with changes in the mechanical properties that determine the physics of poorer left ventricular filling. These findings provide mechanistic insight into, and independent validation of the appropriateness of the 2016 guidelines for assessment of DD.

中文翻译：

---

2016 年美国超声心动图学会/欧洲心血管成像协会评估射血分数降低心力衰竭舒张功能障碍指南的机制验证

美国超声心动图学会/欧洲心血管影像学会 (ASE/EACVI) 2016 年舒张功能障碍 (DD) 评估指南主要基于舒张功能障碍对左心室充盈血流动力学的影响。然而，这些措施不能提供有关舒张功能的可量化机械信息。参数化舒张充盈 (PDF) 形式主义是一个经过验证的理论框架，它根据左心室充盈的物理特性描述了 DD。我们假设 PDF 分析可以提供对控制更高等级 DD 的机械性能的机械洞察力。根据 2016 年 ASE/EACVI 指南，超声心动图显示左心室射血分数降低（< 45%）的患者被前瞻性地分类为 DD 级。使用 PDF 形式主义分析使用二尖瓣血流的脉冲波多普勒在自由呼吸期间获得的连续 E 波。较高的 DD 等级（2 级或 3 级，n = 20 与 1 级，n = 30）与腔室刚度增加（261 ± 71 与 169 ± 61 g/s2，p < 0.001）、填充能量增加（2.0 ± 0.9）相关与 1.0 ± 0.5 mJ，p < 0.001）和更大的峰值阻力（中位数 [四分位距]，18 [15-24] 与 11 [8-14] mN，p < 0.001）。DD 等级与腔室粘弹性无关（21 ± 4 对 20 ± 6 g/s，p = 0.32）。刚度与射血分数呈负相关（r = - 0.39，p = 0.005）。更高级别的 DD 与机械特性的变化有关，这些变化决定了左心室充盈较差的物理特性。这些发现提供了机械洞察力，