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Derivation and Evaluation of Age-Specific Multivariate Reference Regions to Aid in Identification of Abnormal Filling
Jonas Selmeryd1, Egil Henriksen1, Håvard Dalen2
1Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden; Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden.
Insights
New reference regions accurately classify left ventricular filling patterns. Abnormal patterns identified using these multivariate reference regions (MVRs) predict poor outcomes in both general and heart attack patient groups.
Area of Science:
- Cardiology
- Echocardiography
- Diastolic Function Assessment
Background:
- Diagnosing left ventricular (LV) diastolic dysfunction requires integrating multiple parameters, as no single measurement suffices.
- Currently, no universally accepted, validated multiparametric algorithm exists for diastolic function assessment.
Purpose of the Study:
- To derive age-specific multivariate reference regions (MVRs) for classifying normal versus abnormal left ventricular (LV) filling patterns.
- To evaluate the prognostic significance of MVR-based classification in different patient cohorts.
Main Methods:
- Utilized data from the HUNT study (n=1,240) to derive univariate reference bands and age-specific MVRs using mitral inflow velocities (E, A) and mitral annular velocity (e').
- Evaluated prognostic impact via Cox regression in a community-based cohort (n=726) and an acute myocardial infarction cohort (n=551) from the VaMIS study.
Main Results:
- Age-specific MVRs and univariate reference bands were established.
- Abnormal LV filling patterns, identified by MVRs, were associated with significantly increased hazard ratios (HR=3.5 in community cohort, HR=1.8 in MI cohort) after adjusting for multiple clinical factors.
Conclusions:
- Age-specific MVRs effectively identify abnormal LV filling patterns.
- This MVR-based classification provides crucial prognostic information in both general and post-myocardial infarction populations.
- Implementing MVRs can enhance diagnostic consistency for various LV filling disorders.
Objectives:
This study aimed to derive age-specific multivariate reference regions (MVRs) able to classify subjects into those having normal or abnormal filling patterns and to evaluate the prognostic impact of this classification.
Background:
The integration of several parameters is necessary to diagnose disorders of left ventricular (LV) filling because no single measurement accurately describes the complexity of diastolic function. However, no generally accepted validated multiparametric algorithm currently exists.
Methods:
A cohort of 1,240 apparently healthy subjects from HUNT (Nord-Trøndelag Health Study) with measured early (E) and late (A) mitral inflow velocity and early mitral annular diastolic tissue velocity (e') were used to derive univariate 95% reference bands and age-specific MVRs. Subsequently, the prognostic impact of this MVR-based classification was evaluated by Cox regression in a community-based cohort (n = 726) and in a cohort of subjects with recent acute myocardial infarction (n = 551). Both evaluation cohorts were derived from VaMIS (the Västmanland Myocardial Infarction Study).
Results:
Univariate reference bands and MVRs are presented graphically and as regression equations. After adjustment for sex, age, hypertension, body mass index, diabetes, prior ischemic heart disease, LV mass, LV ejection fraction, and left atrial size, the hazard ratio associated with abnormal filling patterns in the community-based cohort was 3.5 (95% confidence interval: 1.7 to 7.0; p < 0.001) and that in the acute myocardial infarction cohort was 1.8 (95% confidence interval: 1.1 to 2.8; p = 0.011).
Conclusions:
This study derived age-specific MVRs for identification of abnormal LV filling patterns and showed, in a community-based cohort and in a cohort of patients with recent acute myocardial infarction, that these MVRs conveyed important prognostic information. An MVR-based classification of LV filling patterns could lead to more consistent diagnostic algorithms for identification of different filling disorders.
