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Correspondence |

Diastolic Dysfunction With Nondilated Left AtriumDiastolic Dysfunction With Nondilated Left Atrium FREE TO VIEW

Eduard Claver, MD; Noelia Cubero, PhD; Àngel R. Cequier
Author and Funding Information

From the Heart Diseases Department (Drs Claver and Cequier) and the Respiratory Diseases Department (Dr Cubero), Hospital de Bellvitge, IDIBELL, Universitat de Barcelona, L’Hospitalet.

Correspondence to: Eduard Claver, MD, Cardiology Department, Echocardiography, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Feixa Llarga sn, 08907, L’Hospitalet de Llobregat, Barcelona, Spain; e-mail: eclaver@bellvitgehospital.cat


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):272-273. doi:10.1378/chest.12-2032
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To the Editor:

We read with great interest the article on cardiac diastolic dysfunction in patients with pulmonary arterial hypertension by Tonelli et al1 published in CHEST (June 2012). We appreciate their original and interesting contribution, especially when there is limited knowledge on the topic. Echocardiography is the most commonly used method for studying diastolic dysfunction. However, we should keep in mind that current echocardiographic diastolic classification may not be suited to respiratory patients because in these patients the volume of the left atrium is decreased, as Tonelli et al1 and other authors2 have reported. In most patients with diastolic dysfunction, the dysfunction occurs when the left atrium is dilated, reflecting the cumulative effects of filling pressures over time. This dilatation is a key point in the diagnosis of diastolic dysfunction, even in mild (or grade I type) cases. In specific patents with a nondilated left atrium, caution should be exercised when diastolic classification is applied.

On the other hand, echocardiographic diastolic classification is complex, and sometimes the parameters obtained may be discordant; thus, classification into diastolic stages can be difficult. When diastolic dysfunction is graded by experienced observers according to current guidelines,3 interobserver variability and accuracy depend on how each investigator resolves conflicting observations that make the classification into one specific type of diastolic dysfunction difficult. It would be interesting to learn if the authors experienced discrepancies with regard to the diastolic classifications, especially when the patients had nondilated left atria, and how they resolved those conflicts.

In conclusion, we want to highlight that in the echocardiography laboratory, it is not always easy to grade diastolic dysfunction. In respiratory patients, the absence of an important parameter such as dilatation of the left atrium can make classification even more complicated.

References

Tonelli AR, Plana JC, Heresi GA, Dweik RA. Prevalence and prognostic value of left ventricular diastolic dysfunction in idiophatic and heritable pulmonary arterial hypertension. Chest. 2012;141(6):1457-1465. [CrossRef] [PubMed]
 
Barr RG, Bluemke DA, Ahmed FS, et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med. 2010;362(3):217-227. [CrossRef] [PubMed]
 
Unzek S, Popovic ZB, Marwick TH; Diastolic Guidelines Concordance Investigators Diastolic Guidelines Concordance Investigators. Effect of recommendations on interobserver consistency of diastolic function evaluation. JACC Cardiovasc Imaging. 2011;4(5):460-467. [CrossRef] [PubMed]
 

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References

Tonelli AR, Plana JC, Heresi GA, Dweik RA. Prevalence and prognostic value of left ventricular diastolic dysfunction in idiophatic and heritable pulmonary arterial hypertension. Chest. 2012;141(6):1457-1465. [CrossRef] [PubMed]
 
Barr RG, Bluemke DA, Ahmed FS, et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med. 2010;362(3):217-227. [CrossRef] [PubMed]
 
Unzek S, Popovic ZB, Marwick TH; Diastolic Guidelines Concordance Investigators Diastolic Guidelines Concordance Investigators. Effect of recommendations on interobserver consistency of diastolic function evaluation. JACC Cardiovasc Imaging. 2011;4(5):460-467. [CrossRef] [PubMed]
 
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