Background
Age‐related changes to left ventricular (LV) early diastolic recoil confound the diagnostic value of e′ velocity in heart failure with preserved ejection fraction (HFpEF). Systolic–diastolic coupling quantifies passive left ventricular elastic recoil and may be superior to e′ in differentiating abnormal diastolic recoil in HFpEF from healthy aging. This study aims to determine the effect of healthy aging and HFpEF on systolic–diastolic coupling.
Methods
Healthy adults (n = 141, aged 20‐90 years) underwent right heart catheterization (RHC) to quantify LV filling pressure and tissue Doppler echocardiography to define peak velocities and excursion (velocity time integral) of the mitral annulus. Separately, HFpEF patients (n = 12, age 67 ± 5 years) and controls (n = 12, age 68 ± 5 years) underwent RHC and echocardiography. Systolic–diastolic coupling was measured as early diastolic excursion (EDexc) divided by systolic excursion (Sexc).
Results
In healthy adults, EDexc/ Sexc declined by 15% per decade of life (r2 = 0.53, P < .001). EDexc/Sexc was significantly lower in HFpEF compared with controls (0.43 ± 0.11 vs 0.56 ± 0.11, P = .011), while e′ was similar (6.2 ± 1.5 vs 6.8 ± 1.3 cm/s, P = .33). Using ROC analysis, EDexc/Sexc had an AUC to detect HFpEF of 0.82 (0.61‐0.95, P = .007), which was superior to e′ alone (AUC 0.60(0.39‐0.80), P = .39; P = .026 for difference).
Conclusions
Systolic–diastolic coupling, quantified by the EDexc/Sexc ratio, declined linearly with healthy aging. The EDexc/Sexc ratio was further reduced in HFpEF and able to predict HFpEF more accurately than e′ alone. Systolic–diastolic coupling may be a useful diagnostic tool to detect HFpEF.
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Introduction:
The E/e’ ratio is often used as a surrogate for left atrial pressure (LAP) despite concerns about reliability and accuracy when LAP is sequentially changed within individuals. This study tested how E/e’ tracks linearly with LAP with the aim of determining if invasive markers of diastolic function are associated with better tracking.
Methods:
Healthy subjects (n = 61, age 52±5 years) underwent manipulation of LAP with 2 levels of lower body negative pressure (LBNP -15 mm Hg, -30mm Hg) and 2 levels of rapid normal saline infusion (NS +15 mL/kg/min, +30 mL/kg/min) with a right heart catheter and echocardiography to define the LV end-diastolic pressure-volume relationship. E/e’ and pulmonary capillary wedge pressure (PCWP) were measured at each condition. Myocardial stiffness was calculated by the slope of the LV pressure-volume curve. LV relaxation was assessed with Tau: (Isovolumetric relaxation time/(ln(Systolic Blood Pressure x 0.9)-ln(PCWP)). R
2
of individual regressions of E/e’ and PCWP for each subject was used to determine quality of tracking across loading conditions.
Results:
PCWP ranged from 5 mm Hg to 20 mm Hg across loading conditions (p <0.001). As a group, E wave velocity demonstrated a consistent linear relationship with PCWP while e’ was more variable
(Figure)
. The mean r
2
of individual regressions was 0.50 ± 0.29 with a high coefficient of variation of 57.1%. Higher baseline PCWP, myocardial stiffness or longer LV relaxation were not associated with improved tracking (p = 0.96, p = 0.55, p = 0.62 respectively).
Conclusion:
This study, the largest cohort to date with experimental altered LAP, highlights the difficulty assessing E/e’: As a cohort, E/e’ tracked with PCWP moderately well, but there was significant variation on an individual level which was independent of baseline LV filling pressure, stiffness and relaxation. Caution should be used when interpreting E/e’ as LAP in healthy individuals even with abnormalities in diastolic filling.
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