Background. In patients with heart failure (HF) assessment of hemodynamic parameters with right heart catheterization (RHC) reveals prognostic information and allows guidance to further treatment options. Recently novel speckle-tracking echocardiographic (STE) parameters were introduced for non-invasive estimation of left ventricular (LV) filling pressure. We aimed to evaluate and compare various conventional echocardiographic and STE parameters of LV diastolic function in patients with HF with reduced ejection fraction (HFrEF) due to ischemic (ICM) and non-ischemic dilated cardiomyopathy (DCM).
Methods. We retrospectively reviewed data of hospitalized HFrEF patients, in whom diagnostic RHC and echocardiography were performed within 24 hours. Parameters of diastolic function assessed by a conventional echocardiographic approach and by STE were evaluated for the association with mean pulmonary capillary wedge pressure (PCWP) and compared in patients with ICM and DCM.
Results. In total, data of 20 pts with DCM and 20 pts with ICM were analyzed (mean age 52±11 and 57±4 years, p=0.07; 30% and 15% women, p=0.45, respectively). No significant differences functional NYHA class, RHC data and most conventional echocardiographic and STE parameters were found between groups. Median NT-pro-BNP level was higher in DCM pts (2642 (IQR: 1796-4973) vs. 1420 (IQR:484-4286) pg/mL, p=0.048). In DCM pts, only early diastolic strain rate (GLSRe) significantly correlated with mean PCWP, whereas in ICM pts, significant correlation was found for most conventional and several STE parameters (Table). Only the ratio of early transmitral flow velocity to mitral annulus early diastolic velocity (E/e’) was able to predict a mean PCWP ≥15 mm Hg (AUC 0.84, 95%CI: 0.61-1.0, p=0.84) in DCM pts. Whereas in ICM pts, most conventional and STE parameters were able to predict elevated mean PCWP. Late diastolic strain rate (GLSRa) and left atrial strain (LAS) showed a predictive value to detect an increased PCWP comparable to E/e’ in ICM pts. E/GLSRa ratio with a cut-off value of 2.4 m and E/LAS ratio with cut-off value of 6.6 cm/s/% were more specific for the detection of PCWP ≥15 mm Hg (sensitivity 89% and specificity 91% for both parameters) compared to E/e’ (sensitivity 89%, specificity 45% for generally accepted cut-off of 14) in pts with ICM (Figure).
Conclusion. Novel STE parameters and their combination with early transmitral flow velocity demonstrated an association with elevated mean PCWP and might be used for non-invasive assessment of increased LV filling pressure in patients with HFrEF due to ICM. In patients with HFrEF due to DCM, a conventional echocardiographic approach for the evaluation of an increased LV filling pressure demonstrated a better association with elevated mean PCWP. Further investigations needed to evaluate proposed parameters for their prognostic role in these groups of patients and in patients with HF with preserved ejection fraction.
Table. Correlation data.
|
|
Pearson correlation coefficient | |
|
DCM N=20 |
ICM N=20 | |
|
E, m/s |
0,171 |
0,469* |
|
A, m/s |
-0,240 |
-0,516* |
|
E/A |
0,275 |
0,464* |
|
IVRT, ms |
-0,228 |
-0,605** |
|
e‘, m/s |
-0,261 |
0,174 |
|
E/e', m/s |
0,418 |
0,399 |
|
GLSRe, s-1 |
0,526* |
0,125 |
|
GLSRa, s-1 |
0,185 |
-0,384 |
|
LAS, % |
0,032 |
-0,521* |
|
E/GLSRe, m |
0,141 |
0,139 |
|
E/GLSRa, m |
-0,206 |
0,524* |
|
E/LAS, m/s/% |
-0,100 |
0,262 |
|
GLSRe/GLSRa |
0,212 |
0,477* |
Figure. ROC curves for echocardiographic parameters to detect mean PCWP ≥15 mm Hg in patients with ICM.
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