Abstract 12468: Hemodynamic Validation of Echocardiographic Left Ventricular to Left Atrial Volumes Ratio Indices in Heart Failure With Preserved Ejection Fraction

Abstract

Introduction: The assessment of mean left atrial (LA) pressure rather than Left Ventricular (LV) end-diastolic pressure reflects more accurately filling pressure which is pathophysiological landmark of Heart Failure with preserved Ejection Fraction (HFpEF). Hypothesis: We sought to test whether the measurement of LV to LA volume ratio at the specific cardiac phases can estimate resting LA pressure in patients with HFpEF. Methods: Fifty-three HFpEF patients (mean age 71+-10 years) who underwent cardiac catheterization including direct, at rest, retrograde LA pressure, were analysed. Echocardiographic data was obtained 1.5+-1.0 hours off cardiac catheterization. Patients were divided into: Group 1 (normal filling pressure) and Group 2 (elevated filling pressure, mean LA pressure >12mmHg and/or pulmonary capillary wedge pressure 14mmHg). The ratio of LV/LA volume was measured in end-systole (LV ES /LA max ), end-diastole (LV ED /LA min ), diastasis (LV dias /LA dias ), and as both maximum (LV ED /LA max ), and minimum (LV ES /LA min ). Results: All measured LV/LA ratios were lower in Group 2 as compared to Group 1 and correlated inversely with an increased LA pressure (LV ED /LA min , r=-0.54, p<0.001; LV ES /LA min , r=-0.53, p<0.001; LV ED /LA max , r=-0.52, p<0.001; LV dias /LA dias , r=-0.50, p<0.001; LV ES /LA max , r=-0.37, p=0.013. The following ratios, LV dias /LA dias , LV ED /LA max , LV ED /LA min , and LV ES /LA min , were the most accurate echocardiographic indices to differentiate HFpEF patients between Group 2 and Group 1 (independently off the presence atrial fibrillation), with the area under the curve >0.75 and statistically noninferior to the following a new LA function parameters such as: LA reservoir strain, index LA reservoir strain, LA total emptying fraction and LA active emptying fraction. The cut-off values for LV ES /LA min <1.45 and LV dias /LA dias <1.30 had the sensitivity 78%, 74% and specificity 71%, 71%, respectively, to differentiate patients between Group 2 and Group 1. Conclusions: Among all studied echocardiographic indices the LV ES /LA min and LV dias /LA dias were the most accurate parameters to assess the level of LA pressure in HFpEF.