Comparing the Performance of Tissue Doppler versus Left Atrial Strain in Predicting Left Ventricular End Diastolic Pressure in Patients with Different Left Ventricular Ejection Fractions | ||||
| Sohag Medical Journal | ||||
| Article 36, Volume 22, Issue 1, January 2018, Page 213-221 PDF (118.89 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/smj.2018.41318 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Aliaa Mahfouz; Mohammed Kamal Salama; Ramadan Ghalib Mohamed; Mohamed Ayman Saleh | ||||
| Department of Cardiovascular Medicine, Aswan University, Aswan, Egypt. | ||||
| Abstract | ||||
| Background:Early trans-mitral inflow velocity and mitral annular tissue Doppler imaging (E/Em ratio) is widely applied to noninvasively estimate left ventricular (LV) filling pressures. However, E/Em ratio has a significant gray zone among patients with severely impaired ejection fraction. Speckle tracking echocardiography (STE) was recently proposed as an alternative surrogate to estimate LV filling pressures. This study aimed at assessing performance of tissue Doppler parameters and left atrial global longitudinal strain as non-invasive surrogates for LV filling pressures and comparing accuracy of these two parameters across different striae of LVEF. Methods: A total of 96 patients with sinus rhythm and different ejection fraction who divided into four groups of 24 patients each according to their EF(>55%, 45–54%, 30–44%, and <30%), had an invasive measurement of the LV pressure. Both medial and lateral E/Em ratio were measured in all subjects by 2D Tissue Doppler, peak atrial longitudinal strain (PALS) and Peak atrial contraction strain (PACS) were obtained by averaging all segments measured in the 4-chamber. Results: Significant Correlation between global PALS and invasive LVEDP in all groups (r = 0.70 P < 0.000), While Lateral E/E’ shows significant correlation only in two groups; preserved and mildly impaired EF (r=0.42 P=0.023, r=0.439 p-0.032; respectively) Conclusion:In patients with preserved or mildly reduced LV ejection fraction, global PALS and Lateral E/E’ ratio presented good correlations with LVEDP. In patients with moderate or severe reduction of EF, E/E’ ratio correlated poorly with invasively measured LV filling pressures. Global PALS provided an overall better estimation of LV filling pressures. | ||||
|
Supplementary Files
|
||||
| References | ||||
|
1. Go, A. S. et al. Heart disease and stroke statistics-2013 update: A Report from the American Heart Association. Circulation127, (2013).
2. Gottdiener, J. S., Kitzman, D. W., Aurigemma, G. P., Arnold, A. M. & Manolio, T. A. Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons > or =65 years of age (the cardiovascular health study). AJC97, 83–89 (2006).
3. Schober, K. E., Luis Fuentes, V. & Bonagura, J. D. Comparison between invasive hemodynamic measurements and noninvasive assessment of left ventricular diastolic function by use of Doppler echocardiography in healthy anesthetized cats. Am. J. Vet. Res.64, 93–103 (2003).
4. Bruch, C., Grude, M., Müller, J., Breithardt, G. & Wichter, T. Usefulness of tissue Doppler imaging for estimation of left ventricular filling pressures in patients with systolic and diastolic heart failure. Am. J. Cardiol.95, 892–895 (2005).
5. Mullens, W., Borowski, A. G., Curtin, R. J., Thomas, J. D. & Tang, W. H. Tissue Doppler imaging in the estimation of intracardiac filling pressure in decompensated patients With advanced systolic heart failure. Circulation119, 62–70 (2009).
6. Cameli, M. et al. Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure. Cardiovasc Ultrasound8, 14 (2010).
7. Cameli, M. et al. Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End-Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction. Echocardiography33, 398–405 (2016).
8. LANG, R. et al. Recommendations for chamber quantification☆. Eur. J. Echocardiogr.7, 79–108 (2006).
9. De Oliveira, R. K. F. et al. Usefulness of pulmonary capillary wedge pressure as a correlate of left ventricular filling pressures in pulmonary arterial hypertension. J. Hear. Lung Transplant.33, 157–162 (2014).
10. Easby, D. & Dalrymple, P. Monitoring arterial, central venous and pulmonary capillary wedge pressure. Anaesthesia and Intensive Care Medicine10, 38–44 (2009).
11. Sharkey, S. W. Beyond the wedge: Clinical physiology and the Swan-Ganz catheter. The American Journal of Medicine83, 111–122 (1987).
12. Kuroda, T. et al. Prediction of prognosis of patients with idiopathic dilated cardiomyopathy: a comparison of echocardiography with cardiac catheterization. Jpn. J. Med.28, 180–8 (1989).
13. Ommen, S. R. et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation102, 1788–1794 (2000).
14. Prasad, A. et al. The Effects of Aging and Physical Activity on Doppler Measures of Diastolic Function. Am. J. Cardiol.99, 1629–1636 (2007).
15. Grossman, William; Baim, D. in Cardiac Catheterization, Angiography, and Intervention 1–17 (2014).
16. Mentz, R. J. et al. Clinical characteristics and outcomes of hospitalized heart failure patients with systolic dysfunction and chronic obstructive pulmonary disease: Findings from OPTIMIZE-HF. Eur. J. Heart Fail.14, 395–403 (2012).
17. Mann, D. L. & Bristow, M. R. Mechanisms and models in heart failure: The biomechanical model and beyond. Circulation111, 2837–2849 (2005).
18. Kusunose, K. et al. Independent association of left atrial function with exercise capacity in patients with preserved ejection fraction. Heart98, 1311–7 (2012).
19. Galderisi, M. et al. European multicentre validation study of the accuracy of E/e’ ratio in estimating invasive left ventricular filling pressure: EURO-FILLING study. Eur. Hear. J. - Cardiovasc. Imaging15, 810–816 (2014)
20. Lang, C. C. & Struthers, A. D. Targeting the renin-angiotensin-aldosterone system in heart failure. Nat. Rev. Cardiol.10, 125–34 (2013).
21. McMurray, J. J. V et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur. Heart J.33, 1787–1847 (2012).
| ||||
|
Statistics Article View: 174 PDF Download: 220 |
||||
