Background: Early mitral inflow velocity to mitral annular early diastolic velocity ratio (E/e') is a standard echocardiographic parameter to non-invasively estimate left ventricular filling pressure (LVFP). Prediction of normal and abnormal LVFP is most reliable when the ratio is ,8 or .15. However, E/e' of 8-15, is indeterminate and remains a significant limitation. We hypothesize that left atrial reservoir strain (LAS) may help improve LVFP assessment. Methods: Patients enrolled in the CATHARSIS prospective study underwent both echocardiography and invasive left heart catheterization simultaneously. Invasive pre-A LVFP, E/e' ratio and LAS were measured in all patients by blinded independent observers. Echocardiography was acquired using GE E9 system and strain analysis was performed offline using EchoPAC. Results: Invasive LVFP was obtained in 140 patients (age 62613, female 22%, ejection fraction 56611%, pre-A pressure 1064.1mmHg). Using a cutoff of #12mmHg to define normal pre-A pressure, ROC curve analysis demonstrated LAS of ,24.10% can identify abnormal LVFP with sensitivity of 78% and specificity of 77% (AUC of 0.79). The mean LAS in patients with normal LVFP was 27.167.7% and 20.967.0% in patients with elevated LVFP (p=0.001). Patients with E/ e',8 were correctly identified with normal LVFP in 33/38 (87%) cases and patients with E/e'.15 were correctly identified with elevated LVFP in 10/16 (62.5%) of cases. Using E/ e' alone to determine LVFP resulted in indeterminate classification in 86/140 (61%) patients of which 18/86 have elevated LVFP and 68/86 have normal LVFP. Application of LAS cut off of 24.10% to the E/e' indeterminate group further identified 53/68 (78%) of patients with normal LVFP and 12/18 (67%) of patients with elevated LVFP. Conclusion: The addition of LAS adds incremental value and improves diagnostic accuracy of LVFP prediction in patients with indeterminate E/e' ratio.
Background: The frequency of reported reproducibility statistics and the proportion of population used for reproducibility assessment is poorly examined within Cardiovascular Imaging (CVI) literature. We aimed to analyse the demonstration of reproducibility of various cardiac imaging modalities reported in original articles amongst 3 CVI journals. Methods: All articles published in JACC CVI, Circulation CVI and EHJ CVI in 2018 were reviewed. Non-original research or irrelevant articles were excluded. Included articles were then evaluated for demonstration of reproducibility, tools used to assess reproducibility, and the proportion of total population used in reproducibility analysis. Results: More than half of the included articles (136/258, 52.7%) did not report reproducibility. Of those, 21.3% (26/ 122) referred to previous reproducibility data and 79.7% (96/ 122) demonstrated reproducibility. Differences in demonstration of reproducibility by modality are as follows: Echo 48% (58/122); CT 24% (9/38); CMR 31% (17/55); Nuclear 32% (8/25); miscellaneous 22% (4/18) (p=0.02). The tools used to demonstrate reproducibility were as follows: Intraclass correlation (ICC) 75% (72/96); Coefficient of Variance 17% (16/96); Bland-Altman 27% (26/96); Correlation 18% (17/96). The proportion of population used to demonstrate reproducibility ranged from 0.8-100%, median 18.6% IQR (7.8%-56.3%). Discussion and Conclusion: Less than half of the manuscripts published in high-impact imaging journals reported or demonstrated reproducibility with significant variety among modalities. ICC was the most common tool used to report reproducibility. There is significant heterogeneity in the proportion of population used to assess reproducibility. Standardised reporting format for reproducibility will reduce variability among CVI articles.
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