Introduction

Heart failure (HF) remains a rising global epidemic, with an estimated prevalence of > 37.7 million individuals globally (1, 2). Excluding sub-Saharan Africa, the rates of death from noncommunicable diseases, such as HF, are increasing worldwide (3). Left ventricular (LV) diastolic dysfunction (DD) is a recognized pathophysiologic mechanism of heart failure (4-6). Moreover, even in the absence of heart failure, DD has been shown to have independent prognostic significance (7, 8). While the gold standard for assessing diastolic dysfunction is thought to be derived from ventricular pressure volume relationships, this invasive approach is rarely used in clinical practice. Echocardiography allows indirect non-invasive evaluation of LV diastolic function (9-11). However, applicability of echocardiography for evaluations of LV filling and relaxation parameters in a clinical setting may be significantly limited if measurements of diastolic parameters are exceedingly time-consuming or affected by reduced feasibility and excessive variability. Therefore, evaluation of the time-consumption, as well as the feasibility and reproducibility, in a realistic clinical setting is important.
The majority of validations studies is reporting re-analyse reproducibility, only few report re-test reproducibility (12, 13). Recently, updated recommendations for the classification of diastolic function has been released (9). Indeed, this algorithm is based on expert consensus and on parameters in which the re-test reproducibility is unknown, stressing the need to validate it in a clinical setting. Presently, the available literature regarding the feasibility and re-test reproducibility of the latest recommended diastolic measurements and their impact on the guideline’s classification algorithms are scarce.
The aim of this study was to evaluate the feasibility, time consumption, and the intra- and inter-observer re-test reproducibility of echocardiographic indexes and classification algorithms of diastolic function.