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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
The E-wave propagation index (EPI): A novel echocardiographic parameter for prediction of left ventricular thrombus.
Thura T Harfi1, Jung-Hee Seo2, Hayder S Yasir3
1Johns Hopkins University, Department of Medicine, Division of Cardiology, Baltimore, MD, United States; Ohio State University, Department of Medicine, Division of Cardiology, Columbus, OH, United States.
Background:
To describe the derivation and validation of a novel echocardiographic metric for prediction of left ventricle thrombus (LVT).
Methods:
Computational fluid dynamic modeling using cardiac CT images was used to derive a novel echocardiography-based metric to predict the presence of LVT. We retrospectively reviewed 25 transthoracic echocardiograms showing definite LVT (LVT group). We then randomly selected 25 patients with LVEF ≥55% (Normal EF group) and 25 patients with severe cardiomyopathy (CMP) with LVEF ≤40% without evidence of LVT (CMP group). The E-wave Propagation Index (EPI) was measured as the E-wave velocity time-integral divided by the LV length. An EPI>1 indicates penetration of the mitral jet into the apex whereas an EPI<1 is indicative of incomplete apical washout. The mean EPI was compared between the three groups. Crude and adjusted odd ratios of EPI and LVT association were also measured.
Results:
Mean EPI was highest for the normal EF group and lowest in the LVT group (1.7 vs. 0.8; p<0.0001). Mean EPI also differed significantly between LVT and CMP groups (0.8 vs. 1.2; p<0.0001). 88% of the LVT group had EPI <1.0 compared to only 20% of the CMP group (p<0.0001). Among the LVT and CMP groups, an EPI <1 increased the odd ratio of LVT by 53.7 times (95% CI: 6.9-416) controlling for LVEF and LV volume.
Conclusions:
The E-wave propagation index is a novel, easily-obtainable, echocardiographic metric to evaluate apical LV flow. An EPI of less than 1 is an independent predictor of LVT formation.
