Filling Pressure In Patients Research Articles

Left ventricular to left arial volume ratio in the assessment of filling pressure in patients with dyspnoea and preserved ejection fraction.

Assessing filling pressure (FP) remains a clinical challenge despite advancements in non-invasive imaging techniques. This study investigates the utility of echocardiographic left ventricular (LV) to left atrial (LA) volume ratio in estimating the resting FP in patients with dyspnoea and preserved ejection fraction (EF). This study is a prospective, single-centre analysis of 53 consecutive patients with dyspnoea (New York Heart Association grade 2 or 3) and LVEF of ≥50% (mean age 71 ± 10 years) who underwent cardiac catheterisation, including direct measurement of LA pressure at rest using retrograde technique. Echocardiographic data were obtained 1.5 ± 1.0 h after cardiac catheterisation. The patients were divided into two groups: Group 1 consisted of individuals with elevated FP, indicated by a mean LA pressure or mean pulmonary capillary wedge pressure of >12 mmHg, and Group 2 comprised of patients with normal FP. The LV and LA volumes were measured at three specific points: the minimum volume (LVES, LAmin), the volume during diastasis (LVdias, LAdias), and the maximum volume (LVED, LAmax). The corresponding LV/LA volume ratios were analysed: end-systole (LVES/LAmax), diastasis (LVdias/LAdias), and end-diastole (LVED/LAmin). The patients in Group 1 exhibited lower LV/LA volume ratios compared with those in Group 2 (LVES/LAmax 0.44 ± 0.12 vs. 0.60 ± 0.23, P = 0.0032; LVdias/LAdias 1.13 ± 0.30 vs. 1.56 ± 0.49, P = 0.0007; LVED/LAmin 2.71 ± 1.57 vs. 4.44 ± 1.70, P = 0.0004). The LV/LA volume ratios correlated inversely with an increased FP (LVES/LAmax, r = -0.40, P = 0.0033; LVdias/LAdias, r = -0.45, P = 0.0007; LVED/LAmin, r = -0.55, P < 0.0001). Among all the measurements, the LVdias/LAdias ratio demonstrated the highest discriminatory power to distinguish patients with elevated FP from normal FP, with a cut-off value of ≤1.24 [area under the curve (AUC) = 0.822] for the entire group, encompassing both sinus rhythm and atrial fibrillation. For patients in sinus rhythm specifically, the cut-off value was ≤1.28 (AUC = 0.799), with P < 0.0001 for both. The LVdias/LAdias index demonstrated non-inferiority to the E/e' ratio [ΔAUC = 0.159, confidence interval (CI) = -0.020-0.338; P = 0.0809], while surpassing the indices of LA reservoir function (ΔAUC = 0.249, CI = 0.044-0.454; P = 0.0176), LA reservoir strain (ΔAUC = 0.333, CI = 0.149-0.517; P = 0.0004), and LAmax index (ΔAUC = 0.224, CI = 0.043-0.406; P = 0.0152) in diagnosing patients with elevated FP. The study presents a straightforward and reproducible method for non-invasive estimation of FP using routine TTE in patients with dyspnoea and preserved EF. The LVdias/LAdias index emerges as a promising indicator for identifying elevated FP, demonstrating comparable or even superior performance to established parameters.

Role of Left Atrial Functions for The Assessment of Left Ventricular Filling Pressure in Patients with Acute Coronary Syndrome.

Role of Left Atrial Functions for The Assessment of Left Ventricular Filling Pressure in Patients with Acute Coronary Syndrome.

Correlation between Echocardiographic Diastolic Parameters and Invasive Measurements of Left Ventricular Filling Pressure in Patients with Takotsubo Cardiomyopathy

The extent of diastolic dysfunction is of clinical importance in the risk stratification and management of patients with Takotsubo cardiomyopathy (TC). Standard echocardiographic indices of diastolic dysfunction have robust predictive ability in assorted disease states, but have not been validated in TC. The aim of this study was to compare Doppler metrics of diastolic function against catheterization-measured filling pressures in TC. Patients with TC who met inclusion and exclusion criteria were evaluated using echocardiography and catheterization performed within 24hours. Both left ventricular (LV) end-diastolic pressure and LV pre-A diastolic pressure were obtained from catheterization tracings. The echocardiographic parameters for diastolic function were extracted using the American Society of Echocardiography recommendations and a previously validated regression equation for mean left atrial pressure (mLAP). A total of 51 patients with TC were included. Patients were predominantly women (72.5%), with a mean age of 58±13years and a mean ejection fraction of 24±10 %. E/e' ratio (septal, average, and lateral) and calculated mLAP correlated positively with catheterization LV pre-A, with fair to moderate correlation (coefficient range, 0.38-0.44). The t-test mean difference between LV pre-A pressure and calculated mLAP was 0.77±7.34mm Hg (95% CI, ±14.68mm Hg) suggesting inconsistent measures. mLAP also exhibited poor diagnostic ability to discriminate elevated LV pre-A diastolic pressure, with an area under the receiver operating characteristic curve of 0.69 (95% CI, 0.50-0.88). Commonly used echocardiographic parameters for diastolic function demonstrated less-than-optimal correlation, with poor sensitivity and specificity, compared with invasively measured LV end-diastolic pressure or LV pre-A wave diastolic pressure in patients with TC. Precise characterization of LV filling pressure in patients with TC using contemporary noninvasive echocardiographic parameters appears challenging. Invasive measurements of filling pressure should remain the gold standard for optimal risk stratification and management of patients with TC.

Impact of elevated left ventricular filling pressure on long-term outcomes after transcatheter aortic valve replacement

BackgroundIncrease in left ventricular filling pressure (FP) and diastolic dysfunction are established consequences of progressive aortic stenosis (AS). However, the impact of elevated FP as detected by pretranscatheter aortic valve...

Incremental Value of Left Atrial Function Analysis in the Assessment of Left Ventricular Filling Pressures in Patients with ST-Elevation Myocardial Infarction.

Background:Left atrial (LA) reservoir strain provides interesting information about left ventricular (LV) filling pressure. However, the advantages of atrial reservoir strain in comparison with conventional parameters in patients with myocardial infarction are not clear yet.Methods:Fifty patients with ST-elevation myocardial infarction (STEMI) prospectively underwent echocardiographic assessment of LV systolic and diastolic function by conventional parameters and two-dimensional speckle tracking longitudinal strain of left atrium. LV filling pressure was estimated by brain natriuretic peptide (BNP) levels.Results:Systolic and conventional diastolic parameters did not show significant differences between patients with increased and normal BNP values, whereas LA reservoir strain was reduced (33.1 ± 8% vs. 46.5 ± 9.8%; P = 0.001) in patients with higher BNP levels. LA reservoir strain had higher area under curve value (0.880) than the other parameters in identifying patients with elevated BNP and a cut-off value of 40.5% reached sensitivity and specificity values of 93% and 86% and positive and negative predictive values of 92% and 85%. LA reservoir strain reclassified 23 patients with increased BNP values, which were previously estimated to have normal (16 patients) and undeterminable LA pressure (seven patients) by using the recommended algorithm for diastolic function.Conclusions:LA reservoir strain is a useful tool for the evaluation of diastolic function and seems to be more sensitive than conventional parameters in the detection of subtle increase of LV filling pressure in patients with STEMI. It allows physicians to reclassify patients with undeterminable diastolic function according to conventional algorithm.

Identifying Discordance of Right- and Left-Ventricular Filling Pressures in Patients With Heart Failure by the Clinical Examination

In ≈25% of patients with heart failure and reduced left-ventricular ejection fraction, right-ventricular (RV), and left-ventricular (LV) filling pressures are discordant (ie, one is elevated while the other is not). Whether clinical assessment allows detection of this discordance is unknown. We sought to determine the agreement of clinically versus invasively determined patterns of ventricular congestion. In 156 heart failure and reduced LV ejection fraction subjects undergoing invasive hemodynamic assessment, we categorized patterns of ventricular congestion (no congestion, RV only, LV only, or both) based on clinical findings of RV (jugular venous distention) or LV (hepatojugular reflux, orthopnea, or bendopnea) congestion. Agreement between clinically and invasively determined (RV congestion if right atrial pressure [RAP] ≥10 mm Hg and LV congestion if pulmonary capillary wedge pressure [PCWP] ≥22 mm Hg) categorizations was the primary end point. The frequency of clinical patterns of congestion was: 51% no congestion, 24% both RV and LV, 21% LV only, and 4% RV only. Jugular venous distention had excellent discrimination for elevated RAP (C=0.88). However, agreement between clinical and invasive congestion patterns was poor, к=0.44 (95% CI, 0.34-0.55). While those with no clinical congestion usually had low RAP and PCWP (67/79, 85%), over one-half (24/38, 64%) with isolated LV clinical congestion had PCWP <22 mm Hg, most (5/7, 71%) with isolated RV clinical congestion had PCWP ≥22 mm Hg, and ≈one-third (10/32, 31%) with both RV and LV clinical congestion had elevated RAP but PCWP <22 mm Hg. While clinical examination allows accurate detection of elevated RAP, it does not allow accurate detection of discordant RV and LV filling pressures.

Alternative Echocardiographic Algorithm for Left Ventricular Filling Pressure in Patients With Heart Failure With Preserved Ejection Fraction

The American Society of Echocardiography and/or the European Association of Cardiovascular Imaging recommend a conventional algorithm for estimating left ventricular (LV) filling pressure in heart failure. However, several patients are classed as "indeterminate" due to their LV filling pressures being impossible to calculate. We investigated whether our new echocardiographic algorithm can predict clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF). We enrolled 754 consecutive patients from the PURSUIT-HFpEF registry. We used the new algorithm to divide them into 2 groups; a normal LV filling pressure group (N group) and a high LV filling pressure group (H group). The H group consisted of 342 patients. Over a mean follow-up of 342 days, 185 patients reached the primary composite end point (157 readmissions for worsening heart failure and 43 cardiovascular deaths). In a multivariable Cox analysis, being in the H group was significantly associated with an increased rate of cardiac events compared with the N group (hazard ratio: 1.71; 95% confidence interval: 1.17 to 2.50, p = 0.006). There were 56 patients (7%) who were assigned to "indeterminate" with the conventional algorithm. Using the new algorithm, we reclassified 16 patients (29%) into the H group and 40 patients (71%) into the N group. The Kaplan-Meier curves showed the reclassified H group had a significantly higher incidence of cardiac events than those assigned to the N group (p < 0.01). In conclusion, the present study demonstrated LV filling pressure assessed by our algorithm can predict clinical outcomes in patients with HFpEF.

Left Atrial Strain as a Single Parameter to Predict Left Ventricular Diastolic Dysfunction and Elevated Left Ventricular Filling Pressure in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Left ventricular diastolic dysfunction (LVDD) is very common among patients undergoing cardiac surgery and is associated with increased mortality and morbidity. The present study tested the hypothesis of whether left atrial strain (LAS) can be used as a single parameter to predict LVDD (per 2016 LVDD evaluation guidelines) and elevated left ventricular filling pressure (LVFP) (ie, LVDD grades II and III) in patients scheduled for off-pump coronary artery bypass grafting (OPCABG) surgery. A prospective observational study. Tertiary-care level hospital. The study comprised 60 patients undergoing elective OPCABG. None. Transthoracic echocardiography was performed within 24 hours of surgery by an anesthesiologist. LVDD was graded per American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations for 2016 LVDD guidelines. Left atrial (LA) function was evaluated using two-dimensional strain measurements obtained with the speckle-tracking echocardiography technique. Receiver operating characteristic curves were constructed, and the area under the curve was derived for the prediction of elevated LVFP by LAS. Fourteen (23.3%) patients had elevated LVFP. Global LA reservoir strain (LASr) reduced significantly as the LVDD grade worsened (28.9% ± 8.3%, 21.8% ± 7.2%, 15.6% ± 4.5% and 11.9% ± 1.3%, respectively, for normal LV diastolic function and grades I, II, and III LVDD; p < 0.0001). Similar trends were noted for other components of LAS; namely, global LA conduction, global LA contraction strain, and LAS rate. The ability to predict high LVFP with LASr was statistically significant, with an area under the receiver operating characteristic curve of 0.92 (confidence interval 0.82-0.97; p < 0.001), and a Youden's index for LASr of 19% was obtained with 85.71% sensitivity and 84.78% specificity. The ability of LAS and its components to predict increased LVFP in various subpopulations (normal v reduced ejection fraction) yielded statistically significant results. In patients scheduled for OPCABG, cardiac anesthesiologists successfully could measure LAS with speckle-tracking echocardiography in the preoperative period. LAS as a single parameter was significantly associated with the grade of LVDD. LASr decreased significantly with worsening grade of LVDD. Furthermore, an LASr value <19% significantly predicted a high LVFP, and LASr predicted high LVFP in both preserved and reduced ejection fraction equally well.

Abstract 13798: Influence of Advanced Pulmonary Vascular Remodeling on Accuracy of Echocardiographic Parameters of Left Ventricular Filling Pressure

Introduction: Evaluation of left ventricular (LV) filling pressure (FP) plays an important role in the clinical management of pulmonary hypertension (PH). However, the accuracy of echocardiographic parameters for the estimation of LV FP in the presence of pulmonary vascular lesions has not been fully addressed. Methods: We investigated 87 patients diagnosed with PH due to pulmonary vascular lesions (non-cardiac PH; PH NC ) (PH NC group) and 117 patients with ischemic heart disease without reduced LV ejection fraction (&lt;40%) (control group). Mean pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) were obtained by right heart catheterization. As echocardiographic parameters of LV FP, the ratio of early- (E) to late-diastolic transmitral flow velocity (E/A), ratio of E to early-diastolic mitral annular velocity (E/e'), and left atrial volume index (LAVI) were measured. The PH NC group was subdivided into non-severe and severe groups according to median PVR (5.3 Wood units). Results: PAWP was 12±5 mmHg in controls, 9±4 mmHg in non-severe PH NC , and 8±3 mmHg in severe PH NC . In the control and non-severe PH NC groups, positive correlations were observed between PAWP and E/A (R=0.66 and R=0.41, respectively), E/e' (R=0.36 and R=0.33), and LAVI (R=0.38 and R=0.62). In contrast, in the severe PH NC group, PAWP was only correlated with LAVI (R=0.41, p=0.006). In the control group, PAWP determined E (β=0.45, p&lt;0.001) but PVR did not, whereas both PAWP and PVR were independent determinants of E (β=0.32, p=0.001; and β=-0.35, p&lt;0.001, respectively) in the PH NC group. Conclusions: In the presence of advanced pulmonary vascular lesions, conventional Doppler echocardiographic parameters may not accurately reflect LV FP. Importantly, elevated PVR would lower the E value, even when PAWP is elevated, resulting in blunting of these parameters for the detection of elevated LV FP. LAVI might be a reliable parameter for estimating LV FP in patients with severe non-cardiac PH.

Impact of Updated 2016 ASE/EACVI VIS-À-VIS 2009 ASE Recommendation on the Prevalence of Diastolic Dysfunction and LV Filling Pressures in Patients with Preserved Ejection Fraction.

BACKGROUNDAssessment of diastolic dysfunction (DD) and left ventricular filling pressures (LVFP) by echocardiography is complex in patients with preserved ejection fraction (EF). The American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) jointly published recommendations in 2016 to simplify the diagnosis and classification of DD and the assessment of LVFP. We aimed to study the impact of the updated 2016 ASE/EACVI guidelines vis-à-vis the 2009 ASE recommendations on prevalence of DD and LVFP in patients with preserved EF.METHODSFive hundred patients referred to the echocardiography laboratory from March 2020 to May 2020 were analyzed. Patients with left ventricular ejection fraction (LVEF) < 50% were excluded. All patients underwent comprehensive transthoracic echocardiography. DD and LVFP were assessed by the 2016 ASE/EACVI and 2009 ASE recommendations. The concordance between the guidelines was analyzed by kappa coefficient and overall proportion of agreement.RESULTSMean age was 53 ± 13 years and 63.4% were men. Prevalence of DD and abnormal LVFP were significantly lower with the 2016 recommendations than with the 2009 recommendations (9.4% vs. 16.8%, p < 0.001 and 8.4% vs. 12.8%, p < 0.05). Patients with Grade 1 DD (100%) and Grade 2 DD (46.4%) were reclassified by the 2016 recommendations. Indeterminate diastolic function (9.8%) was strikingly high according to the 2016 recommendations. The concordance between the two recommendations was moderate (kappa = 0.569). The overall proportion of agreement was 85.4%.CONCLUSIONSPrevalence of DD and abnormal LV filling pressures were lower with application of the 2016 ASE/EACVI recommendations in patients with preserved EF. There was moderate agreement between the 2009 and 2016 recommendations.

Echocardiographic Evaluation of Left Ventricular Filling Pressure in Patients With Heart Failure With Preserved Ejection Fraction: Usefulness of Inferior Vena Cava Measurements and 2016 EACVI/ASE Recommendations

The left ventricular filling pressure (LVFP) is correlated to right atrial pressure (RAP) in heart failure. We compared diagnostic value of the inferior vena cava (IVC) measurements to the one of the 2016 echocardiographic recommendations to estimate LVFP in patients with suspected heart failure with preserved ejection fraction (HFpEF). Invasive hemodynamics and echocardiography were obtained within 48 hours in 132 consecutive patients with left ventricular ejection fraction ≥50%, and suspected pulmonary hypertension. Increased LVFP was defined by a pulmonary artery wedge pressure (PAWP) >15 mmHg. Of 83 patients in sinus rhythm, a score of the 2016 recommendations ≥ 2 (E/e' ratio >14 and/or tricuspid regurgitation velocity >2.8 m/s and/or indexed left atrial volume>34 mL /m²) had a positive predictive value (PPV) of 63% for PAWP>15 mmHg, whereas a dilated IVC (>2.1 cm) and/or non-collapsible (≤50%) had a PPV of 82%. The net reclassification improvement was 0.39 (P < .05). In atrial fibrillation (AF), a dilated and/or non-collapsible IVC had an 86% PPV for PAWP>15 mmHg. The correlation between RAP and PAWP was 0.60, with 75.7% concordance (100/132) between dichotomized pressures (both RAP>8 mmHg and PAWP>15 mmHg and vice versa). The IVC size and collapsibility is valuable to identify patients with HFpEF with high LVFP in both sinus rhythm and AF.

281 Accuracy of the E/e’ Ratio as a Measure of Left Ventricular Filling Pressures in Patients with Non ST-Elevation Myocardial Infarction

281 Accuracy of the E/e’ Ratio as a Measure of Left Ventricular Filling Pressures in Patients with Non ST-Elevation Myocardial Infarction

356 Incremental Value of Left Atrial Strain in Evaluation of Left Ventricular Filling Pressures in Patients With Indeterminate E/e’: Invasive and Echocardiographic Correlation From the CATHARSIS Study

356 Incremental Value of Left Atrial Strain in Evaluation of Left Ventricular Filling Pressures in Patients With Indeterminate E/e’: Invasive and Echocardiographic Correlation From the CATHARSIS Study

Hemodynamic Validation of the E/e’ Ratio as a Measure of Left Ventricular Filling Pressure in Patients With Non-ST Elevation Myocardial Infarction

The E/e' ratio has an established role in the assessment of left ventricular filling pressure (LVFP) in stable patients, but its accuracy in acute myocardial ischemia is less well established. The aim of this study was to validate the relation between the E/e' ratio and invasively measured LVFP in patients with non-ST elevation myocardial infarction (NSTEMI). A total of 120 unselected patients with NSTEMI underwent cardiac catheterization with measurement of left ventricular end-diastolic pressure (LVEDP; elevated ≥15 mm Hg) and Doppler echocardiography with either simultaneous (n = 30) or same-day (n = 90) measurement of E/e'. Patients were aged 64.1 ± 11.8 years, 72% were male and mean left ventricular ejection fraction was 48.0 ± 20.9%. Septal, lateral, and average E/e' ratios all showed a significant correlation with LVEDP (Pearson's r: 0.42, 0.43, 0.48, respectively [all p <0.001]). Receiver operating characteristics curves showed an area under the curve of 0.72, 0.72, and 0.75 (all p <0.001) for septal, lateral, and average E/e', respectively. The sensitivity, specificity, positive (PPV), and negative (NPV) predictive values for the guideline-recommended threshold of average E/e' >14 for elevated LVEDP was 27%, 93%, 79%, and 44%, respectively. Utilizing lower E/e' boundaries of 6, 7, and 8 for lateral, average, and medial E/e', respectively, improved the NPV to ≥80% for each parameter. In conclusion, the E/e' ratio is a robust measure of LVFP during acute NSTEMI using upper and lower thresholds to achieve a high PPV and NPV, respectively, with the use of adjunctive guideline-recommend measures required in patients with nonconclusive E/e'.

Mean Right Atrial Pressure for Estimation of Left Ventricular Filling Pressure in Patients with Normal Left Ventricular Ejection Fraction: Invasive and Noninvasive Validation

There is a paucity of data on the utility of right atrial pressure (RAP) for estimating pulmonary capillary wedge pressure (PCWP) in patients with normal ejection fraction (EF), including patients with heart failure with preserved EF. Mean RAP was compared with PCWP in 129 patients (mean age, 61±11years; 45% men) with exertional dyspnea enrolled in a multicenter study. Measurements included left ventricular volumes, EF, and mitral inflow velocities. Mean PCWP was 14±7mmHg, and mean RAP was 8±5mmHg. A significant relation was presentbetween mean RAP and mean PCWP (r2=0.5, P<.001). RAP > 8mm Hg had 76% sensitivity and 86% specificity in detecting mean PCWP > 12mm Hg. In 101 patients with inconclusive mitral filling pattern (defined according to American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 diastolic function recommendations), RAP by catheterization had sensitivity of 73% and specificity of 91%. In a subset of 59 patients with echocardiographic assessment of mean RAP, RAP by echocardiography had sensitivity of 76% and specificity of 89%. Mean RAP provides useful information about mean PCWP in many patients with normal left ventricular EF. There is good sensitivity and excellent specificity when combining invasive or noninvasive RAP and mitral velocities to determine if PCWP is elevated.

Noninvasive Assessment of the Left Ventricular Filling Pressure in Patients with Liver Cirrhosis

Noninvasive Assessment of the Left Ventricular Filling Pressure in Patients with Liver Cirrhosis

E/E’ Ratio as a Noninvasive Measure of Left Ventricular Filling Pressure in Patients with Non-ST-elevation Acute Coronary Syndromes (NSTEACS)

Background: The E/e’ ratio has an established role in the assessment of left ventricular filling pressures (LVFP) in stable patients. There is limited data on the assessment of LVFP with the E/E’ in patients with NSTEMI. We sought to perform an invasive haemodynamic validation study with near-simultaneous measurement of Doppler echocardiographic parameters and invasively measured LVFP in patients with NSTEMI. Methods: A total of 29 unselected patients with NSTEMI underwent a limited transthoracic echocardiogram on the cardiac catheterisation table immediately prior to coronary angiography. Mitral inflow E-wave and tissue Doppler derived E’ at the septal and lateral mitral annulus was measured. Invasive measurement of LVFP was then performed with a pigtail catheter in mid shallow expiration. Results: The mean age of patients was 64.1 years, with 72% males. The mean LVEF was 52%. Angiographic findings included 3-vessel disease in 12.5% and LAD culprit lesions in 25%. Septal E/E’ had a good correlation with LVEDP (Spearman's rho 0.603,p=0.001). The lateral E/E’ also had a good correlation with LVEDP (Spearman's rho 0.548,p=0.002). In a multivariate analysis for the predictors of elevated LVEDP(≥16 mmHg) incorporating E velocity, E/A ratio, deceleration time (DT) and septal and lateral E/E's, the septal E/E’ was the only independent predictor (OR = 11.9(95%CI 9.4-14.0), p=.047). A septal E/E’ cutoff of 15 identified 5/12 cases of LVEDP >16 mmHg whilst an E/E’ cutoff identified 10/12 cases of LVEDP >16 mmHg. Conclusions: Septal E/E’ ratio is a valid non-invasive assessment of elevated filling pressures in patients with NSTEMI.

Correlation of Global Strain Rate and Left Ventricular Filling Pressure in Patients with Coronary Artery Disease: A 2-D Speckle-Tracking Study

The aim of the present study was to evaluate the role of 2-D speckle-tracking imaging in the prediction of left ventricular filling pressure in patients with coronary artery disease (CAD) and normal left ventricular ejection fraction (LVEF). Eighty-four patients with CAD and 30 healthy controls were recruited prospectively. The longitudinal strain rate (SR) curves were determined in three apical views of the left ventricle long axis. Circumferential and radial SR curves were determined in three short-axis views. Left ventricular end-diastolic pressure (LVEDP) was invasively obtained by left heart catheterization. Compared with the 30 controls, the patients with CAD had significantly lower global SR during early diastole (SRe) and higher E/SRe in three directions of myocardial deformation. CAD patients with elevated LVEDP had significantly lower SRe and higher E/SRe of three deformations. Pearson's correlation analysis revealed that LVEDP correlated positively with E/E′ ratio, radial SRe and longitudinal and circumferential E/SRe. LVEDP correlated negatively with longitudinal and circumferential SRe and radial E/SRe. Receiver operating characteristic curve analysis revealed that these SR indexes predicted elevated LVEDP (areas under the curve: longitudinal E/SRe = 0.74, circumferential E/SRe = 0.74, circumferential SRe = 0.70, longitudinal SRe = 0.69, radial E/SRe = 0.68, radial SRe = 0.65), but neither was superior to the tissue Doppler imaging index E/E' (area under the curve = 0.84). The present study indicates that 2-D speckle-tracking imaging is a practical method for evaluating LV filling pressure, but it might not provide additional advantages compared with E/E′ in CAD patients.

Abstract 15435: Myocardial Deformation at Rest Predicts Exercise-induced Elevation in Left Ventricular Filling Pressure in Patients With Exertional Dyspnea

Background: An exaggerated rise in the pulmonary arterial wedge pressure (PAWP) with exercise is a hallmark of heart failure. However, conventional resting-state measures of cardiac structure and function poorly predict exercise hemodynamics. We determined whether LV longitudinal strain (LS) and circumferential strain (CS) predict exercise-induced rise in PAWP. Methods: We studied 85 patients referred for cardiopulmonary exercise testing with invasive hemodynamic monitoring for evaluation of dyspnea. Patients with an LVEF&lt;50% or moderate or greater valvular disease were excluded. All patients underwent rest echocardiography followed by exercise testing with invasive hemodynamic monitoring. Global longitudinal strain (LS), global circumferential strain (CS) and the CS/LS-ratio were measured by 2D speckle-tracking echocardiography. Results: Mean age was 53±18 years, 25% were male, 41% had hypertension, and 9% had diabetes mellitus. Lower absolute LS at rest was associated with greater increase in PAWP during exercise (r=0.23, p=0.033). In contrast, higher absolute CS at rest predicted a greater increase in PAWP (r=-0.27, p=0.025) and greater increase in stroke volume with exercise (r=-0.26, p=0.044). Higher CS/LS-ratio was most predictive of elevation in PAWP with exercise (r=0.27, p=0.023; Figure). Conclusion: Myocardial deformation at rest predicts exercise-induced rise in PAWP among patients with dyspnea and a preserved LVEF. A pattern of rest deformation characterized by worse LS and exaggerated CS is most strongly associated with exercise-induced rise in PAWP.

Impact of inodilator drugs on echocardiographic assessments of left ventricular filling pressure in patients with decompensated end-stage heart failure*.

We investigated the impact of inodilators on the accuracy of E/e' ratio as a surrogate for pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure. The ratio of early diastolic transmitral flow velocity to tissue Doppler mitral annular early diastolic velocity, E/e', and pulmonary artery occlusion pressure have been shown to be correlated. The validity of E/e' for predicting pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure was recently challenged, but the influence of inodilators was not taken into account, despite the reported influence of these drugs on left ventricular relaxation properties. Invasive hemodynamic monitoring and echocardiographic data were collected prospectively from 39 patients with decompensated end-stage systolic heart failure (92% male), aged 56 ± 13 years. These patients had dilated ventricles with a low cardiac index (1.9 ± 0.6 L/min/m) and high pulmonary artery occlusion pressure (22 ± 8 mm Hg), and 90% required inodilator support during hospitalization. The correlation between septal E/e' and pulmonary artery occlusion pressure was good for examinations in the absence of inodilators (n = 21) (r = 0.7; p < 0.001), but no correlation was found when inodilators were used (n = 31). Lateral and mean E/e' were poorly correlated with pulmonary artery occlusion pressure, if at all, in both cases. By modifying ventricular relaxation properties and the influence of filling pressure on e', inodilator agents severely impair the correlation between E/e' and pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure.