E/e` ratio is superior to speckle tracking for detecting elevated left ventricular end‐diastolic pressure in patients with coronary artery disease and preserved ejection fraction

Júnior, Antonio Amador Calvilho; Assef, Jorge Eduardo; Bihan, David Costa de Souza Le; Barretto, Rodrigo Bellio de Mattos; Filho, Antonio Tito Paladino; Abizaid, Alexandre; Braga, Sérgio L. N.; Vilela, Andréa de Andrade; Pedra, Simone Rolim Fernandes Fontes; Jesus, Carlos Alberto de

doi:10.1111/echo.14407

Cited by 7 publications

(4 citation statements)

References 33 publications

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“…The accuracy of PFR combined with TPF in predicting LVEDP ≥ 16mmHg is better than that of echocardiography alone. Secondly, we applied a correlation analysis between diastolic function parameters obtained by planar MUGA and echocardiography and LVEDP, suggesting a better correlation between PFR, TPF, PFR combined with TPF, and LVEDP, which is in line with Patel et alAmong the echocardiographic parameters, the correlation between the average E/e’ ratio and LVEDP was better, which is similar to the results of previous studies [ 19 ]. These parameters may provide a good screen individually and, in combination, would be a powerful tool to assess LV diastolic function.…”

Section: Discussionsupporting

confidence: 88%

Diagnostic value of parameters derived from planar MUGA for detecting HFpEF in coronary artery disease patients

Liu

Zhou

et al. 2023

BMC Cardiovasc Disord

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Background In recent years, heart failure with preserved ejection fraction (HFpEF) has received increasing clinical attention. To investigate the diagnostic value of diastolic function parameters derived from planar gated blood-pool imaging (MUGA) for detecting HFpEF in coronary atherosclerotic heart disease (coronary artery disease, CAD) patients. Methods Ninety-seven CAD patients with left ventricular ejection fraction ≥ 50% were included in the study. Based on the left ventricular end-diastolic pressure (LVEDP), the patients were divided into the HFpEF group (LVEDP ≥ 16 mmHg, 47 cases) and the normal LV diastolic function group (LVEDP < 16 mmHg, 50 cases). Diastolic function parameters obtained by planar MUGA include peak filling rate (PFR), filling fraction during the first third of diastole (1/3FF), filling rate during the first third of diastole (1/3FR), mean filling rate during diastole (MFR), and peak filling time (TPF). Echocardiographic parameters include left atrial volume index (LAVI), peak tricuspid regurgitation velocity (peak TR velocity), transmitral diastolic early peak inflow velocity (E), average early diastolic velocities of mitral annulars (average e′), average E/e′ ratio. The diastolic function parameters obtained by planar MUGA were compared with those obtained by echocardiography to explore the clinical value of planar MUGA for detecting HFpEF. Results The Receiver-operating characteristic curve analysis of diastolic function parameters obtained from planar MUGA and echocardiography to detect HFpEF showed that: among the parameters examined by planar MUGA, the area under the curve (AUC) of PFR, 1/3FF, 1/3FR, MFR and TPF were 0.827, 0.662, 0.653, 0.663 and 0.809, respectively. Among the echocardiographic parameters, the AUCs for average e′, average E/e′ ratio, peak TR velocity, and LAVI values were 0.747, 0.706, 0.735, and 0.633. The combination of PFR and TPF showed an AUC of 0.856. PFR combined with TPF value demonstrated better predictive value than average e′ (Z = 2.020, P = 0.043). Conclusion Diastolic function parameters obtained by planar MUGA can be used to diagnose HFpEF in CAD patients. PFR combined with TPF was superior to the parameters obtained by echocardiography and showed good sensitivity and predictive power for detecting HFpEF.

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Section: Discussionsupporting

confidence: 88%

Diagnostic value of parameters derived from planar MUGA for detecting HFpEF in coronary artery disease patients

Liu

Zhou

et al. 2023

BMC Cardiovasc Disord

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“…LAVI is a consequence of long-standing elevated lling pressures, but lling pressures might be normal at the time of catheterization. [6,21,22] Conclusions Our results suggest that, compared to invasive measurements, both the Simpson method and the M-mode echocardiographic underestimate LV ejection fraction in healthy individuals. Compared to M-mode echocardiographic, measurements using the Simpson method result in higher LV systolic volume and lower diastolic volume, leading to lower LV ejection fraction.…”

Section: Discussionmentioning

confidence: 80%

Comparison between Invasive and Echocardiographic Assessment of Left Ventricular Function in Healthy participants

Li¹,

Mutailipu²,

Zhou³

et al. 2022

Preprint

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Objectives Accurate assessment of LV function is of great importance but still challenging. Despite the invasive measure is the gold standard, non-invasive ultrasound is widely used due to its convenience. We aimed to compare the accuracy of several methods assessing LV function in echocardiography.Methods 49 healthy participants who underwent transthoracic echocardiography and catheterization simultaneously were included. Invasive LVEF and LVFP were measured with Sandler-Dodge method. Non-invasive LV systolic function was measured with both the M-mode method and the modified Simpson method. Parameters related to LV diastolic function in echocardiography including E/A, E/e′, tricuspid regurgitation velocity, left atrial volume index, etc., were measured.Results Correlations between invasive and non-invasive LVESV, LVEDV, and LVEF were not significant ((P=0.07 and P=0.97, P=0.17 and P=0.74, P=0.64 and P=0.52). Compared to invasive measurements, the modified Simpson method overestimated the LV end-systolic volume (P=0.001), and M-mode method overestimated the LV end-diastolic volume (P=0.047). Both of these two methods underestimated the LVEF (P=0.027 and P<0.001). Invasive left ventricular end-diastolic pressure (LVEDP) was elevated in 23 of the 49 patients (47%). Compared to participants with normal LVEDP, participants with elevated LVEDP (>16mmHg) had higher A peak velocity (P=0.009) and lower E/A ratio (P=0.001). Multiple linear regression showed that, among all parameters related to LV diastolic function, only E/A significantly associated with LVEDP after adjustment (P=0.006). We further compared the sensitivity and specificity of E/A ,E/e’ and the method recommended by 2016 ASE/EACVI guideline in identifying LV diastolic dysfunction. E/A was with both higher sensitivity and higher specificity in the detection of LVEDP elevation. Conclusions Both the Simpson method and the M-mode method underestimate the LVEF. In terms of LV diastolic function assessment, E/A ratio is better associated with invasively-measured LVEDP compared to other conventional parameters.

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“…[13][14][15][16] Despite the favorable results of these techniques, their effective implementation to this end did not occur, which may be explained, among other reasons, by the complexity of these analyses compared to the traditional measures of LV DF by Doppler echocardiography. 17 However, although the assessment of LV filling pressure by STE is not part of 2016 recommendations for the assessment of DF, STE is indeed recommended to determine myocardial disease, especially LV global longitudinal strain, which may be used to determine myocardial disease and thus help in the initial analysis of DF. 18 What is the role of LA in the assessment of LV DF?…”

Section: Quantification Of Cardiac Mechanics and Its Studies In Diast...mentioning

confidence: 99%

Left Atrial Strain in the Analysis of LV Diastolic Function: Ready to Use?

Júnior¹,

Assef²,

Braga³

et al. 2023

ABC Imagem Cardiovascular

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Left atrial (LA) dilation is a common indicator of diastolic dysfunction, and its analysis through a volume calculation reflects the cumulative effects of the left ventricular (LV) filling pressures. However, an increase in LA volume is not exclusive to diastolic dysfunction, which has also been observed in other clinical conditions. Thus, the evaluation of the LA strain enables a functional study of this chamber, adding to the morphological analysis through the volume calculation.The LA strain, measured using the speckle tracking technique, brings information on the reservoir, conduction, and contractile functions of the LA, and is related to the LV function. Moreover, the changes in the LA strain precede the volumetric changes by nearly a decade, and correlate inversely with the degree of LA fibrosisthis has an important relationship with the diastolic dysfunction and its grading system. Albeit insufficient to explain its totality, LA fibrosis can partially justify the functional changes of this heart chamber and can favor the use of this variable as a complement to the current protocols for the analysis of the diastolic function.Although further study is still warranted to establish other clinical applications, the LA strain stands out in the analysis of diastolic dysfunction and can be considered ready to use, offering a great potential to improve the evaluation of the overall cardiac function.

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E/e` ratio is superior to speckle tracking for detecting elevated left ventricular end‐diastolic pressure in patients with coronary artery disease and preserved ejection fraction

Cited by 7 publications

References 33 publications

Diagnostic value of parameters derived from planar MUGA for detecting HFpEF in coronary artery disease patients

Diagnostic value of parameters derived from planar MUGA for detecting HFpEF in coronary artery disease patients

Comparison between Invasive and Echocardiographic Assessment of Left Ventricular Function in Healthy participants

Left Atrial Strain in the Analysis of LV Diastolic Function: Ready to Use?

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