Document Detail

Do additional echocardiographic variables increase the accuracy of E/e' for predicting left ventricular filling pressure in normal ejection fraction? An echocardiographic and invasive hemodynamic study.
MedLine Citation:
PMID:  20152696     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There are few data on adding left atrial volume index (LAVi) or pulmonary artery systolic pressure (PAP) to the ratio of early mitral inflow to mitral annular velocity (E/e') for the estimation of left ventricular (LV) filling pressure in patients with preserved LV ejection fractions (LVEFs) (>50%).
METHODS: Patients underwent echocardiography within 20 minutes of cardiac catheterization. Echocardiographic variables were compared with invasively measured LV preatrial contraction pressure (pre-A).
RESULTS: Of the 122 patients studied (mean age, 55 +/- 9 years; mean LVEF, 61 +/- 6%), 67 (55%) were women, 108 (88%) had hypertension, and 79 (65%) had significant coronary artery disease at catheterization. E/e' was significantly correlated with pre-A (R = 0.63, P < .0001) compared with LAVi (R = 0.49, P < .001) and PAP (R = 0.48, P < .001). E/e' > 13 had sensitivity of 70% and specificity of 93% (area under the curve [AUC], 0.82; P < .0001), LAVi > 31 mL/m2 had sensitivity of 78% and specificity of 76% (AUC, 0.80, P < .001), and PAP > 28 mm Hg had sensitivity of 80% and specificity of 64% for pre-A > 15 mm Hg (AUC, 0.77, P < .001). Adding LAVi >31 mL/m2 for E/e' = 8 to 13 significantly increased the accuracy of E/e' > 13 alone (sensitivity, 87%; specificity, 88%; AUC, 0.89; P = .01 for comparison). However, adding PAP > 28 mm Hg for E/e' = 8 to 13 did not significantly increase the accuracy of E/e' > 13 alone (AUC, 0.82; sensitivity, 82%; specificity, 72%; P = NS for comparison).
CONCLUSIONS: In patients with preserved LVEFs, adding LAVi > 31 mL/m2 to E/e' (when E/e' was in the gray zone, but not when E/e' was >13) significantly increased the accuracy of E/e' alone for the estimation of LV filling pressure. These data support the notion of using several, rather than any single, Doppler echocardiographic parameter for the accurate assessment of LV diastolic function.
Hisham Dokainish; John S Nguyen; Ranjita Sengupta; Manu Pillai; Mahboob Alam; Jaromir Bobek; Nasser Lakkis
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  23     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-15     Completed Date:  2010-05-18     Revised Date:  2011-06-17    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  156-61     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
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MeSH Terms
Blood Pressure*
Echocardiography / methods*
Image Interpretation, Computer-Assisted / methods*
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Stroke Volume*
Ventricular Dysfunction, Left / ultrasonography*
Comment In:
J Am Soc Echocardiogr. 2010 Feb;23(2):162-3   [PMID:  20152697 ]
Curr Cardiol Rep. 2011 Jun;13(3):170-2   [PMID:  21287299 ]

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