What is the management approach for grade one impaired relaxation on echocardiogram (ECHO) with no other abnormal findings?

From the Guidelines

Grade one impaired relaxation on echocardiogram with no other abnormal findings typically requires no specific treatment if the patient is asymptomatic, with management focusing on addressing underlying risk factors through lifestyle modifications and monitoring. The approach to managing grade one impaired relaxation on echocardiogram without other abnormal findings prioritizes the patient's overall health and risk factors. Key considerations include:

• Addressing hypertension, diabetes, and obesity through lifestyle modifications such as regular exercise, weight management, sodium restriction, and smoking cessation 1.
• Controlling blood pressure in hypertensive patients, aiming for targets below 130/80 mmHg using antihypertensive medications like ACE inhibitors or ARBs 1.
• Tight glycemic control for patients with diabetes.
• If symptoms of heart failure develop, treatment may include diuretics like furosemide 20-40 mg daily to reduce fluid overload and improve symptoms. The rationale for this approach is based on the understanding that grade one diastolic dysfunction represents the mildest form of impaired ventricular relaxation and often does not progress or cause clinical symptoms 1. Regular follow-up with repeat echocardiography every 1-2 years is reasonable to monitor for progression, particularly in patients with risk factors for heart disease 1. It's essential to consider the clinical implications of diastolic dysfunction, including the potential for high left ventricular filling pressures and the importance of distinguishing between impaired relaxation and restrictive filling patterns 1. However, given the mild nature of grade one impaired relaxation, a conservative approach prioritizing risk factor management and symptom monitoring is generally recommended 1.

From the Research

Management Approach for Grade One Impaired Relaxation on Echocardiogram

• The management approach for grade one impaired relaxation on echocardiogram with no other abnormal findings is not explicitly stated in the provided studies, but some insights can be gained from the available evidence.
• A study published in the Journal of the American Society of Echocardiography 2 found that impaired relaxation mitral inflow pattern (grade 1 diastolic function) is common in older adults and is associated with cause-specific death, highlighting this simple echocardiographic finding as a potential biomarker of cardiovascular and cognitive risk.
• Another study published in ESC heart failure 3 examined risk factors associated with asymptomatic echocardiographic structural, systolic, and diastolic abnormalities and found that increased age, blood pressure, amino-terminal pro-B-type natriuretic peptide level, and warfarin therapy were risk factors for isolated diastolic abnormality.
• The use of beta-blockers in the treatment of diastolic heart failure is discussed in a study published in the Indian heart journal 4, which suggests that beta-blockade is effective in the prevention of heart failure in certain patient populations.

Risk Factors and Associations

• The following risk factors and associations have been identified in the provided studies:
  • Increased age, blood pressure, and amino-terminal pro-B-type natriuretic peptide level are associated with isolated diastolic abnormality 3.
  • The D allele of the angiotensin-converting enzyme (ACE) gene is associated with early diastolic dysfunction in hypertension 5.
  • Impaired relaxation mitral inflow pattern (grade 1 diastolic function) is associated with cause-specific death, including cardiovascular and cognitive risk 2.

Echocardiographic Findings

• The provided studies discuss various echocardiographic findings, including:
  • Impaired relaxation mitral inflow pattern (grade 1 diastolic function) 2.
  • Diastolic dysfunction, as assessed by four-dimensional echocardiography 5.
  • Structural, systolic, and diastolic echocardiographic abnormalities, as defined by the Atherosclerosis Risk in Communities study criteria 3.