Question

[lvspro]

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For all you heart genies.
I tried finding the 4 stages of diastolic dysfunction, and have ran into a wall... so-to-speak.
I tried googling, harrisons, and emedicine, and none had the EXACT answer to my Q. Plenty of these articles discuss the dysfunction itself, but not the stages. I'm on a cardio rotation, and was asked this today. After standing there with a deer-in-headlights expression on my face, I just told him I didn't know, and said I would look it up.
Thanks in advance.

 

[raph91]

I don't suppose he may have been talking about the stages of heart failure based on physical limitations, ie,
Stage I – no limitations of physical activity, ordinary physical activity does not lead to undue fatigue or shortness of breath
Stage II – slight limitation of physical activity is seen. Patient is comfortable at rest or ordinary physical activity results in fatigue, palpitations or shortness of breath
Stage III – marked limitations of physical activity are seen. Patient is comfortable at rest but even slight physical activity causes fatigue, palpitations or shortness of breath.
Stage IV – symptoms of cardiac insufficiency are present at rest, and discomfort is increased with any physical activity.

You can look at the ACC/AHA guidelines-
A. Patients at high risk of developing HF because of the presence of conditions that are strongly associated with the development of HF (HTN, DM, CAD family history of CMP). Such patients have no identified structural or functional abnormalities of the pericardium, myocardium, or cardiac valves and have never shown signs or symptoms of HF.
B. Patients who have developed structural heart disease (previous MI, LV dysfunction, valvular heart disease) that is strongly associated with the development of HF but who have never shown signs or symptoms of HF.
C. Patients who have current or prior symptoms of HF (dyspnea, fatigue, impaired exercise tolerance) associated with underlying structural heart disease.
D. Patients with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions.

I remember reading of 3 stages associated with diastolic dysfunction, but I can't remember completely where I read it, when I read it, or if this is exactly right -
Stage I - reduced LV filling (early diastole) and nml LV and LA pressures and normal compliance
Stage II - pseudonormalization (characterized by nml Doppler echocardiographic transmitral flow pattern due to opposing increase in LA pressures)
Stage III - severe restrictive diastolic filling with marked decrease in LV compliance

 

[DrHeartMD]

My interpretation of the question (as I was asked this question once) is that you are referring to echocardiographic stagings of diastolic dysfunction...in which case any echo text will do this better than me, but for quick answer reference (and this one satisfied my cards attending)...

These refer to doppler patterns through the mitral annulus (i.e. ventricular inflow tract)

stage/grade 1: E:A ratio approaching 1
stage/grade 2: E:A ratio less than 1 (i.e. larger A wave than E wave)
stage/grade 3: Pseudonormalization of the E:A ratio (Both E wave and A wave enlarge, with E wave larger than A wave as is normally found, but both are elevated due to relaxation difficulty, and time course for the wave is shorter)
stage/grade 4: Disappearance of the A wave (the atria cannot contract against a very rigid ventricle so the A wave disappears)

this is a basic explanation...if you need a better explanation of the wave forms or what they mean post back here in the forum

 

[lvspro]

My interpretation of the question (as I was asked this question once) is that you are referring to echocardiographic stagings of diastolic dysfunction...in which case any echo text will do this better than me, but for quick answer reference (and this one satisfied my cards attending)...

These refer to doppler patterns through the mitral annulus (i.e. ventricular inflow tract)

stage/grade 1: E:A ratio approaching 1
stage/grade 2: E:A ratio less than 1 (i.e. larger A wave than E wave)
stage/grade 3: Pseudonormalization of the E:A ratio (Both E wave and A wave enlarge, with E wave larger than A wave as is normally found, but both are elevated due to relaxation difficulty, and time course for the wave is shorter)
stage/grade 4: Disappearance of the A wave (the atria cannot contract against a very rigid ventricle so the A wave disappears)

this is a basic explanation...if you need a better explanation of the wave forms or what they mean post back here in the forum

DrJ nailed it.
I found an article for CME in a critical care journal that does a good job explaining diastolic failure, stages, tx etc... Anyhow, I found it last night a little while after I posted my Q.
If anyones' interested in the article, lemme know and I'll post it.