Abstract
BackgroundSystolic left ventricular function strongly influences the blood pressure waveform. Therefore, pressure-derived parameters might potentially be used as non-invasive, diagnostic markers of left ventricular impairment. The aim of this study was to investigate the performance of pressure-based parameters in combination with electrocardiography (ECG) for the detection of left ventricular systolic dysfunction defined as severely reduced ejection fraction (EF).Methods and resultsTwo populations, each comprising patients with reduced EF and pressure-matched controls, were included for the main analysis (51/102 patients) and model testing (44/88 patients). Central pressure was derived from radial readings and used to compute blood flow. Subsequently, pulse wave analysis and wave intensity analysis were performed and the ratio of the two peaks of forward intensity (SDR) was calculated as a novel index of ventricular function. SDR was significantly decreased in the reduced EF group (2.5 vs. 4.4, P<0.001), as was central pulse pressure, augmentation index and ejection duration (ED), while the QRS-duration was prolonged. SDR and ED were independent predictors of ventricular impairment and when combined with QRS in a simple decision tree, a reduced EF could be detected with a sensitivity of 92% and a specificity of 80%. The independent power of ED, SDR and QRS to predict reduced EF was furthermore confirmed in the test population.ConclusionThe detection or indication of reduced ejection fraction from pressure-derived parameters seems feasible. These parameters could help to improve the quality of cardiovascular risk stratification or might be used in screening strategies in the general population.
Highlights
Heart failure represents a serious global health problem that is becoming more and more frequent in the aging population: prognoses in the US predict prevalence to rise by 46% from 2012 to 2030 [1]
The aim of this study was to investigate the performance of pressure-based parameters in combination with electrocardiography (ECG) for the detection of left ventricular systolic dysfunction defined as severely reduced ejection fraction (EF)
Anthropometric measures as well as the prevalence of coronary artery disease, hypertension and diabetes were comparable between the groups, but antihypertensive medication was more common in reduced EF patients
Summary
Heart failure represents a serious global health problem that is becoming more and more frequent in the aging population: prognoses in the US predict prevalence to rise by 46% from 2012 to 2030 [1]. In patients with asymptomatic left ventricular systolic dysfunction, pharmacological treatment may delay or even halt the progression of the disease [2] and the early detection of a potentially impaired systolic function, ideally at a primary care level, may be of great value. Electrocardiography (ECG) is recommended as first line investigation for suspected heart failure [2,3]. Parameters describing pulsatile hemodynamics might be used for diagnosis as well, since an impairment of systolic ventricular function strongly influences the resulting pressure and flow waveforms. Systolic left ventricular function strongly influences the blood pressure waveform. The aim of this study was to investigate the performance of pressure-based parameters in combination with electrocardiography (ECG) for the detection of left ventricular systolic dysfunction defined as severely reduced ejection fraction (EF)
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