What Is the Evidence That the Tissue Doppler Index E/e′ Reflects Left Ventricular Filling Pressure Changes After Exercise or Pharmacological Intervention for Evaluating Diastolic Function? A Systematic Review

Sharifov, Oleg F.; Gupta, Himanshu

doi:10.1161/jaha.116.004766

Cited by 56 publications

(52 citation statements)

References 66 publications

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“…This is not always doable for breast cancer patients with expanders or prostheses. Moreover, we considered that E/E' does not help to diagnose DD in patients with preserved LVEF [21,22]. Here, patients diagnosed with grade I DD by E/A and DT did not develop E/E' abnormalities, which was consistent with this notion.…”

Section: Study Limitations and Strengthssupporting

confidence: 82%

Early Diastolic Dysfunction after Cancer Chemotherapy: Primary Endpoint Results of a Multicenter Cardio-Oncology Study

et al. 2018

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Asymptomatic diastolic dysfunction (DD) with preserved left ventricular ejection fraction (LVEF) is suspected to precede late cardiac events in cancer survivors treated by chemotherapy. We conducted the first multicenter study of early DD induced by chemotherapy. Patients who were candidates for standard dose chemotherapy were screened for the absence of cardiovascular risk factors, LVEF ≥50%, normal-for-age diastolic function at echocardiography (E/A ratio, E wave deceleration time; DT), normal levels of potential DD biomarkers like Nt-proBNP (≤125 pg/mL), and cardiac troponin I (cTnI, ≤0.05 ng/mL). Mitral Doppler (E/E’) was left at the investigator’s discretion. Chemotherapy-induced DD with preserved LVEF was diagnosed for patients showing LVEF ≥50% and any of the following: Nt-proBNP > 125 pg/mL, cTnI > 0.05 ng/mL, and out-of-range E/A and DT. Eighty patients (68 males, 12 females, median age 49 years) were evaluated at 1 week after chemotherapy (T1). Thirty-three protocol-defined diastolic events were observed (15 Nt-proBNP > 125 pg/mL, 14 grade I DD by E/A and DT, 4 cTnI > 0.05 ng/mL). The events occurred in 29 asymptomatic patients with LVEF ≥50% (36% incidence of DD with preserved LVEF). Interactions occurred between biomarkers and grade I DD. E/E’ abnormalities were not observed. Both anthracycline-based and nonanthracycline regimens induced DD. These findings show that biomarkers and echocardiography intercept early DD in otherwise asymptomatic low-risk cancer patients treated by standard dose chemotherapy. These findings therefore call for the adequate cardiac management of cancer patients.

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Section: Study Limitations and Strengthssupporting

confidence: 82%

Early Diastolic Dysfunction after Cancer Chemotherapy: Primary Endpoint Results of a Multicenter Cardio-Oncology Study

et al. 2018

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“…Regarding the use of effort‐related diastolic dysfunction as a predictor of coronary restenosis, Gibby and Burgess et al demonstrated that predefined cutoffs for postexercise E / e' > 13 had moderate sensitivity and good specificity for identifying elevated LVFP . In contrast, a recent systematic review suggested that current evidence is insufficient to conclude that E/e' is reliable for assessing LVFP changes in response to exercise or other interventions . In the current study, the mean values for both pre‐ and post‐TET E/e' were lower than 13 in the restenosis group.…”

Section: Discussioncontrasting

confidence: 59%

Relationship of left atrial expansion index to exercise tolerance, pretest probability of restenosis, and positive predictive value of treadmill test in coronary artery disease

Hsiao

2020

Echocardiography

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Background Whether left atrial (LA) expansion index is associated with coronary restenosis, and exercise capacity (EC) reduction in coronary artery disease has not been established. Methods This study analyzed 342 consecutive patients who had received a coronary stent implant. A treadmill exercise test (TET) was administered in all participants. The LA expansion indices were measured immediately before and after TET. Maximal EC measured on a breath‐by‐breath basis by a metabolic cart with gas analyzers and recorded as metabolic equivalent task. All patients with positive TET results received angiography, and those with restenosis received complete revascularization by either percutaneous coronary intervention (PCI) or bypass surgery. The LA expansion index and EC before and 1 month after PCI were then compared. Results Out of 342 patients, 74 had positive TET results, and 54 had restenosis in angiography. Low LA expansion index was associated with poor EC. In patients with LA expansion index > 200%, only 5% had restenosis with 38.5% positive predictive value (PPV) of TET. In patients with LA expansion index < 100%, however, 64.3% had restenosis with 94.7% PPV of TET. Restenosis induced low pre‐TET LA expansion index and further decline during TET. The LA expansion index significantly (P .001) improved from 133 ± 64% before PCI to184 ± 86% after PCI, and the improvement corresponded with EC recovery. A 10% reduction in LA expansion index was associated with a 15% increase in pretest probability of restenosis. Conclusion The LA expansion index is associated with EC, pretest probability of restenosis, and PPV of TET. Revascularization improves both EC and LA expansion index.

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“…found E/e’ useful in improving identification of patients with HFpEF (Obokata et al ., ). However, changes in E/e’ failed to correlate with LA or LV pressures in most studies (Choi et al ., ; Manouras et al ., ; Bhella et al ., ; Santos et al ., ), irrespective of LV systolic function (Sharifov & Gupta, ). This concludes that E/e’ at both rest and exercise cannot be relied on to reflect changes in filling pressures, in patients other than those in end‐stage heart failure (Nagueh et al ., ; Ommen et al ., ).…”

Section: Discussionmentioning

confidence: 99%

Can Doppler echocardiography estimate raised pulmonary capillary wedge pressure provoked by passive leg lifting in suspected heart failure?

Henein

Tossavainen

Aroch

et al. 2018

Clin Physio Funct Imaging

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Summary Aims Non‐invasive estimation of left ventricular filling pressure (LVFP) during stress is important for explaining exertional symptoms in patients with heart failure (HF). The aim of this study was to evaluate ability of Doppler echocardiographic measures of elevated LVFP with passive leg lifting (PLL) in patients with suspected HF. Methods Twenty‐nine patients with clinical signs of HF who underwent simultaneous Doppler echocardiography and right heart catheterization (RHC) at rest and during PLL were consecutively investigated. Seventeen patients had normal PCWP (≤15 mmHg) at rest and during PLL and 12 with normal PCWP at rest but >15 mmHg with PLL. Conventional echo and 2D strain were used to assess early diastolic blood flow velocity (E), LV strain rate during early diastole (LVSRe), left atrial SR during atrial contraction (LASRa) and myocardial tissue Doppler velocities to assess lateral e’ and further calculate E/e’ and E/LVSRe and their relationship with PCWP, at rest and during PLL. Results Resting LAVI (β = 0·45, P = 0·009) and LASRa (β = −0·51, P = 0·004) were independently related to PCWP during PLL. Also, LASRa (β = −0·77, P<0·001), E/e’ (β = 0·40, P = 0·04) and E/LVSRe (β = 0·47, P = 0·021) during PLL correlated with PCWP during PLL. Multiple regression analysis identified E/LVSRe (β = 0·46, P = 0·001) and LASRa (β = −0·58, P = 0·002) during PLL as being independently associated with PCWP during PLL. Conclusion Left atrial volume and myocardial contraction (LASRa) at rest both predict unstable LV filling pressures measured as raised PCWP when provoked by PLL. Furthermore, LASRa at PLL seems to have the strongest association to PCWP during PLL.

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What Is the Evidence That the Tissue Doppler Index E/e′ Reflects Left Ventricular Filling Pressure Changes After Exercise or Pharmacological Intervention for Evaluating Diastolic Function? A Systematic Review

Cited by 56 publications

References 66 publications

Early Diastolic Dysfunction after Cancer Chemotherapy: Primary Endpoint Results of a Multicenter Cardio-Oncology Study

Early Diastolic Dysfunction after Cancer Chemotherapy: Primary Endpoint Results of a Multicenter Cardio-Oncology Study

Relationship of left atrial expansion index to exercise tolerance, pretest probability of restenosis, and positive predictive value of treadmill test in coronary artery disease

Can Doppler echocardiography estimate raised pulmonary capillary wedge pressure provoked by passive leg lifting in suspected heart failure?

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