Arq Bras Cardiol: Imagem cardiovasc. 2025; 38(1): e20250013

Misinterpretation of Indeterminate Diastolic Function: Awareness and Insights from a Survey among Brazilian Cardiologists

Daniela do Carmo

Rassi

, Salvador

Rassi

, Jorge Eduardo

Assef

, Alex dos Santos

Felix

, Adenalva Lima de Souza

Beck

, Cecília Beatriz Bittencourt Viana

Cruz

, Silvio Henrique

Barberato

DOI: 10.36660/abcimg.20250013i

Abstract

Background:

Diastolic dysfunction (DD) is highly prevalent and is associated with significant morbidity and mortality. More recent guidelines have introduced the classification of Indeterminate Diastolic Function or Indeterminate Diastolic Dysfunction (IDF or IDD). Nevertheless, both diagnoses are still poorly understood in clinical practice, with variable prevalence.

Objectives:

Assess the understanding of IDF and IDD among non-echocardiographer cardiologists in Brazil.

Methods:

A nationwide online survey was conducted among non-echocardiography readers cardiologists via mobile messaging platforms. A brief and anonymous questionnaire on knowledge and interpretation of Diastolic Function.

Results:

A total of 570 cardiologists from all regions of Brazil participated in the study. Most participants (64.21%) had more than ten years of clinical experience. While 71% correctly identified grades 2 or 3 as indicative of elevated filling pressures, only 34.21% accurately understood the diagnostic criteria for IDF or IDD. Among the mistakes associated with the indeterminate classification, the following stand out: attribution of this status to conditions that interfere with the assessment of diastole (49.12%), technical limitations of the echocardiography equipment (3.33%), and alleged lack of knowledge by echocardiographers (4.91%). In addition, 46.7% reported finding this diagnosis rarely in the reports, 33.5% believed that this classification influenced clinical conduct, and 43.5% considered that the examination could have been better performed.

Conclusion:

Despite knowledge about diastolic function, misinterpretation of IDF or IDD is still common among non-echocardiographer cardiologists. Investment in education, sharing these concepts with clinicians, and clear guidelines are essential to optimize the use and diagnostic accuracy of echocardiography.