381 Novel Combined Algorithm to Assess Left Ventricular Diastolic Function and Filling Pressures: Correlation With Filling Pressures and Outcomes

Abstract

A novel combined algorithm has been proposed utilising guideline recommended diastolic parameters that can be applied to all patients regardless of LVEF. This study sought to determine the haemodynamic and prognostic validity of this new algorithm in patients with myocardial infarction(MI). A retrospective single centre study involving 277 patients with a first-ever MI was performed. Outcomes data were obtained from the national death registry. Echocardiography was performed early post-admission for all patients. Significant diastolic dysfunction (DD) was defined was grade 2/3 DD according to the novel algorithm. Haemodynamic correlation involved 54 patients who underwent either same-day or simultaneous cardiac catheterisation or echocardiography. With respect to outcomes, there were a total of 40 MACE events (median follow-up of 2 years). Significant DD was significantly associated with MACE on Kaplan-Meier analysis: log-rank χ2 22.08(p<0.001). In a multivariate Cox proportional hazards model incorporating significant clinical factors (age, chronic kidney disease) and LVEF, significant DD was the most powerful predictor of outcomes (HR 2.71[95% CI 1.28-5.71]; p=0.008). In the haemodynamic study, LVEDP was noted to be elevated in patients with significant DD: mean LVEDP 21.1+7.9mmHg versus 13.2+6.1mmHg (p=0.001). Receiver operating curves showed an area under the curve of 0.814(p<0.001) for assessing elevated LVEDP. The calculated sensitivity, specificity, positive predictive value(PPV) and negative predictive value for LVEDP>15 mmHg was 41.7%, 87.1%, 78.9%, and 56.3% respectively. Significant DD assessed using the novel combined algorithm (i) was an independent predictor of clinical outcomes and (ii) detects elevated LVEDP with a high specificity and PPV.