New, Simple Echocardiographic Indexes for the Estimation of Filling Pressure in Patients with Cardiac Disease and Preserved Left Ventricular Ejection Fraction

Dokainish, Hisham; Nguyen, John; Sengupta, Ranjita; Pillai, Manu; Alam, Mahboob; Bobek, Jaromir; Lakkis, Nasser

doi:10.1111/j.1540-8175.2010.01177.x

Cited by 23 publications

(18 citation statements)

References 35 publications

(80 reference statements)

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“…4 In the current work, we did not analyze incremental power of other echocardiographic indices that might favor the diagnostic accuracy of E/ e. Because of the complexity of the topic, such analysis would require separate studies. We should, however, point out that by using broad search terminology in our search terms, we found very few studies 27,[33][34][35]43 that addressed this aspect in their studies. Most of them have similar study limitations as just given here (mostly with low patient cohort and heterogeneous design).…”

Section: Significance Of Intermediate E/ E Zonementioning

confidence: 99%

Diagnostic Accuracy of Tissue Doppler Index E/è for Evaluating Left Ventricular Filling Pressure and Diastolic Dysfunction/Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta‐Analysis

Sharifov

Schiros

Aban

et al. 2016

JAHA

173

119

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BackgroundTissue Doppler index E/è is used clinically and in multidisciplinary research for estimation of left ventricular filling pressure (LVFP) and diastolic dysfunction (DD)/heart failure with preserved ejection fraction (HFpEF). Its diagnostic accuracy is not well studied.Methods and ResultsFrom the PubMed, Scopus, Embase, and Cochrane databases, we identified 24 studies reporting E/è and invasive LVFP in preserved EF (≥50%). In random‐effects models, E/è had poor to mediocre linear correlation with LVFP. Summary sensitivity and specificity (with 95% CIs) for the American Society of Echocardiography–recommended E/è cutoffs (lateral, mean, and septal, respectively) to identify elevated LVFP was estimated by using hierarchical summary receiver operating characteristic analysis. Summary sensitivity was 30% (9–48%), 37% (13–61%), and 24% (6–46%), and summary specificity was 92% (82–100%), 91% (80–99%), and 98% (92–100%). Positive likelihood ratio (LR+) was <5 for lateral and mean E/è. LR+ was slightly >10 for septal E/è obtained from 4 studies (cumulative sample size <220). For excluding elevated LVFP, summary sensitivity for E/è (lateral, mean, and septal, respectively) was 64% (38–86%), 36% (3–74%), and 50% (14–81%), while summary specificity was 73% (54–89%), 83% (49–100%), and 89% (66–100%). Because of data set limitations, meaningful inference for identifying HFpEF by using E/è could not be drawn. With the use of quality assessment tool for diagnostic accuracy studies (Quality Assessment of Diagnostic Accuracy Studies questionnaire), we found substantial risks of bias and/or applicability.ConclusionsThere is insufficient evidence to support that E/è can reliably estimate LVFP in preserved EF. The diagnostic accuracy of E/è to identify/exclude elevated LVFP and DD/HFpEF is limited and requires further validation in a well‐designed prospective clinical trial.

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Section: Significance Of Intermediate E/ E Zonementioning

confidence: 99%

Diagnostic Accuracy of Tissue Doppler Index E/è for Evaluating Left Ventricular Filling Pressure and Diastolic Dysfunction/Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta‐Analysis

Sharifov

Schiros

Aban

et al. 2016

JAHA

173

119

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“…In particular, E wave velocity is correlated to patients with pulmonary capillary wedge pressure [26,27]. In outpatients with preserved systolic function but significant ischemic or hypertensive heart disease, low (< 60 cm/s) or high (> 90 cm/s) E wave velocities are correlated with low and high left ventricular end diastolic pressure (LVEDP), respectively [45]. Similarly, our findings show that baseline E wave velocity was also significantly lower in R at 65 cm/s (53, 76) than in NR patients at 82 cm/s (75, 93) ( P = 0.0005).…”

Section: Discussionmentioning

confidence: 99%

Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use

Muller

Bobbia²,

Toumi³

et al. 2012

Crit Care

323

239

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IntroductionTo investigate whether respiratory variation of inferior vena cava diameter (cIVC) predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure (ACF).MethodsForty patients with ACF and spontaneous breathing were included. Response to fluid challenge was defined as a 15% increase of subaortic velocity time index (VTI) measured by transthoracic echocardiography. Inferior vena cava diameters were recorded by a subcostal view using M Mode. The cIVC was calculated as follows: (Dmax - Dmin/Dmax) × 100 and then receiver operating characteristic (ROC) curves were generated for cIVC, baseline VTI, E wave velocity, E/A and E/Ea ratios.ResultsAmong 40 included patients, 20 (50%) were responders (R). The causes of ACF were sepsis (n = 24), haemorrhage (n = 11), and dehydration (n = 5). The area under the ROC curve for cIVC was 0.77 (95% CI: 0.60-0.88). The best cutoff value was 40% (Se = 70%, Sp = 80%). The AUC of the ROC curves for baseline E wave velocity, VTI, E/A ratio, E/Ea ratio were 0.83 (95% CI: 0.68-0.93), 0.78 (95% CI: 0.61-0.88), 0.76 (95% CI: 0.59-0.89), 0.58 (95% CI: 0.41-0.75), respectively. The differences between AUC the ROC curves for cIVC and baseline E wave velocity, baseline VTI, baseline E/A ratio, and baseline E/Ea ratio were not statistically different (p = 0.46, p = 0.99, p = 1.00, p = 0.26, respectively).ConclusionIn spontaneously breathing patients with ACF, high cIVC values (>40%) are usually associated with fluid responsiveness while low values (< 40%) do not exclude fluid responsiveness.

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“…10,11 Moreover, E/e' has been shown to be independently predictive of cardiovascular events. 12,13 Recently, Dokainish et al 14 proposed a novel echocardiographic equation, (E+LAVI)/2, which has comparable accuracy to E/e' for LV end-diastolic pressure estimation and adds incremental value to E/e' alone when E/e' is in the grey zone. age-and sex-adjusted N-terminal pro-brain natriuretic peptide values.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of heart failure with preserved ejection fraction: which parameters and diagnostic strategies are more valuable?

Shuai

Chen

Yongxin

et al. 2011

European J of Heart Fail

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AimsThere are no unified criteria for diagnosing heart failure with preserved ejection fraction (HFpEF). The aim of this study was to evaluate the present main diagnostic criteria and to discover which parameters and strategies are more valuable. Methods and resultsEchocardiographic data and plasma N-terminal pro-brain natriuretic peptide levels were assessed in a derivation cohort (n ¼ 236) and a validation cohort (n ¼ 98). Both cohorts included normal controls, patients with hypertensive heart disease without heart failure and patients with HFpEF. In the derivation cohort, the ratio of early mitral inflow velocity to tissue Doppler velocity at lateral mitral annulus (lateral E/e' ≥ 12), left atrial volume index (LAVI ≥ 34 mL/m 2 ), and the difference between duration of reversed pulmonary vein atrial systole flow and duration of mitral A wave flow (Ard -Ad . 30 ms) had the greatest diagnostic value among all the single parameters. A brief strategy that consisted of either: (i) lateral E/e' ≥ 12; or (ii) 12 . lateral E/e' ≥ 8, with either LAVI ≥ 34 mL/m 2 or Ard-Ad . 30 ms, provided good diagnostic accuracy for identifying diastolic dysfunction in HFpEF, with a sensitivity of 77% and specificity of 81%. These observations were confirmed in the validation cohort. ConclusionEchocardiographic parameters including lateral E/e', LAVI, and Ard-Ad have the greatest value in diagnosing HFpEF. A brief strategy that included these three parameters had great diagnostic value and would be simple to use in clinic practice.--

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New, Simple Echocardiographic Indexes for the Estimation of Filling Pressure in Patients with Cardiac Disease and Preserved Left Ventricular Ejection Fraction

Cited by 23 publications

References 35 publications

Diagnostic Accuracy of Tissue Doppler Index E/è for Evaluating Left Ventricular Filling Pressure and Diastolic Dysfunction/Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta‐Analysis

Diagnostic Accuracy of Tissue Doppler Index E/è for Evaluating Left Ventricular Filling Pressure and Diastolic Dysfunction/Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta‐Analysis

Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use

Diagnosis of heart failure with preserved ejection fraction: which parameters and diagnostic strategies are more valuable?

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