Estimation of Mean Left Atrial Pressure in Patients with Acute Coronary Syndromes: A Doppler Echocardiographic and Cardiac Catheterization Study

Tachjian, Ara; Sanghai, Saket; Stencel, Jason; Parker, Matthew W.; Kakouros, Nikolaos; Aurigemma, Gerard P.

doi:10.1016/j.echo.2018.11.002

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…E/e' mean correlated with LVMDP in the entire cohort; however, the correlation was weak in the CAD group. Weaker correlation between E/e' mean and LVMDP in patients with acute coronary syndrome and preserved LVEF compared to those with reduced LVEF has been recently reported 37. Whether simple or combined conventional echocardiographic metrics such as IVRT, e' and/ or E/e' can be effective to identify early DD (eg, due to hypertension and/or CAD) needs further validation.…”

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confidence: 96%

Echocardiographic diagnosis of left ventricular diastolic dysfunction: Impact of coronary artery disease

et al. 2020

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Background In 2016, the American Society of Echocardiography (ASE) released guidelines for identifying left ventricular (LV) diastolic dysfunction (DD), but its ability to detect early hemodynamic abnormalities is not well established, especially in the setting of subclinical coronary artery disease (CAD). We hypothesize that the accuracy of ASE categorization of early LVDD is affected by knowledge of whether CAD history is present. Methods We studied 34 patients (age 62 ± 7 years) with NYHA class I to II symptoms and with transthoracic echocardiography without findings suggesting myocardial disease (all with preserved LV ejection fraction), who underwent cardiac catheterization with high‐fidelity LV pressure measurement. Echocardiographic images were evaluated for LVDD using ASE algorithm without and with knowledge of CAD history and angiography findings. CAD was considered as having DD for the algorithm. Results CAD was identified in 22 patients at catheterization (65%). Using ASE guidelines without including history of CAD or angiographic results, 29 patients were DD−, 3 were DD+ (all grade II), and 2 were indeterminate. Inclusion of CAD history recategorized 59% (n = 20) patients to DD+ (all grade I) from DD− (P < .0001). Nineteen of the recategorized patients (95%) had increased isovolumetric relaxation time (IVRT). The addition of echocardiographic IVRT improved discrimination between DD− and DD+, when the presence of CAD is unknown. Conclusions 2016‐ASE algorithm reasonably accurately identifies early LVDD at rest as reflected by LV catheterization when CAD is disclosed, but without knowledge of the presence of CAD, it underdiagnoses DD+ grade I. The addition of IVRT may improve early LVDD diagnostics.

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confidence: 96%

Echocardiographic diagnosis of left ventricular diastolic dysfunction: Impact of coronary artery disease

et al. 2020

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“…This underscores the concerns that the MAC algorithm and traditional echocardiographic diastolic parameters are unable to track left ventricular filling pressures in patients with MAC. In patients without annular calcification, E/e’ ratio is useful in refining mean left atrial pressure estimates, specifically in ACS patients as recently reported by Tachjian et al 14 However, MAC uncouples this relationship 7,15 . The correlation between markers of abnormal relaxation (IVRT and E‐wave deceleration) and LVFP suggest that surrogate measurements of myocardial stiffness may have utility in differentiating patients with high filling pressure.…”

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confidence: 93%

Evaluating a decision tool for diagnosing diastolic dysfunction and estimation of left ventricular filling pressures in the presence of mitral annular calcium

et al. 2020

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Objectives This study sought to evaluate a decision algorithm for the estimation of left ventricular filling pressure (LVFP) in patients with mitral annular calcification (MAC). Background In a single center study, Abudiab et al evaluated echocardiographic parameters to estimate LVFP in patients with MAC against invasive hemodynamic measurements and developed a decision algorithm which demonstrated high predictive accuracy. Methods Retrospectively, 55 patients (mean age 68.5 ± 11.5) with MAC and a left heart catheterization within 24 hours of an echocardiogram were identified. The decision algorithm was applied using echo data to classify patients as having normal or elevated LVFP which was then compared with the invasively obtained LVFP. Results The algorithm performed poorly at predicting pre‐A LVFP as normal or high (P = .182). Accuracy for the algorithm was 0.59 [0.46, 0.72] (mean [95% CI]), sensitivity was 0.45 [0.28, 0.62], specificity was 0.73 [0.54, 0.86], false positive rate was 0.27 [0.14, 0.46], and false negative rate was 0.55 [0.38, 0.72]. E/A ratio, IVRT, and E/e'ratio showed no significant relationship to actual patient LVFP. Conclusions The Abudiab et al algorithm failed to demonstrate comparable sensitivity, specificity, and accuracy in our sample. Additional study is necessary to refine this tool prior to more widespread use in clinical practice.

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“…Lin et al have demonstrated the prognostic value of E/e' in patients that underwent PCI after non-ST elevation acute myocardial infarction [9]. Other studies analyzing patients with ACS have showed that the E/e' ratio correlates well to measured LA pressure [24] and is a powerful predictor of adverse events [1,4,7]. TDI analysis in patients with suspected NSTE-ACS has potential cost savings, as shown by Vijay S Gc et al [4].…”

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confidence: 99%

The Incremental Prognostic Value of E/(e’×s’) Ratio in Non-ST-Segment Elevated Acute Coronary Syndrome

et al. 2021

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It has been shown that the E/(e’×s’) index, which associates a marker of diastolic function (E/e’, early transmitral/diastolic mitral annulus velocity ratio) and a parameter that explores LV systolic performance (s’, systolic mitral annulus velocity), is a good predictor of outcome in acute anterior myocardial infarction. There are no studies that have investigated the prognostic value of E/(e’×s’) in a non-ST-segment elevated acute coronary syndrome (NSTE-ACS) population. Echocardiography was performed in 307 consecutive hospitalized patients with NSTE-ACS and succesful percutaneous coronary intervention, before discharge and six weeks after. The primary endpoint consisted of cardiac death or readmission due to re-infarction or heart failure. During the follow-up period (25.4 ± 3 months), cardiac events occurred in 106 patients (34.5%). Receiver operating characteristic (ROC) analysis identified E/(e’×s’) at discharge as the best independent predictor of composite outcome. The optimal cut-off value was 1.63 (74% sensitivity, 67% specificity). By multivariate Cox regression analysis, E/(e’×s’) was the only independent predictor of cardiac events. Kaplan–Meier analysis identified that patients with an initial E/(e’×s’) > 1.63 that worsened after six weeks presented the worst prognosis regarding composite outcome, readmission, and cardiac death (all p < 0.001). In conclusion, in NSTE-ACS, E/(e’×s’) is a powerful predictor of clinical outcome, particularly if it is accompanied by worsening after 6-weeks.

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Estimation of Mean Left Atrial Pressure in Patients with Acute Coronary Syndromes: A Doppler Echocardiographic and Cardiac Catheterization Study

Cited by 11 publications

References 18 publications

Echocardiographic diagnosis of left ventricular diastolic dysfunction: Impact of coronary artery disease

Echocardiographic diagnosis of left ventricular diastolic dysfunction: Impact of coronary artery disease

Evaluating a decision tool for diagnosing diastolic dysfunction and estimation of left ventricular filling pressures in the presence of mitral annular calcium

The Incremental Prognostic Value of E/(e’×s’) Ratio in Non-ST-Segment Elevated Acute Coronary Syndrome

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