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Correlation between Echocardiographic Diastolic Parameters and Invasive Measurements of Left Ventricular Filling
John S Dayco1, Riyad Y Kherallah2, Josh Epstein3
1Division of Cardiology, Department of Medicine, Wayne State University, Detroit, Michigan.
Insights
Echocardiography metrics for diastolic dysfunction in Takotsubo cardiomyopathy (TC) showed poor correlation with invasive measurements. Invasive filling pressures remain crucial for accurate risk stratification and management in TC patients.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure
Background:
- Diastolic dysfunction assessment is vital for risk stratification in Takotsubo cardiomyopathy (TC).
- Standard echocardiographic indices for diastolic dysfunction lack validation in TC.
- This study aimed to compare Doppler-derived diastolic function metrics with catheterization-measured filling pressures in TC.
Purpose of the Study:
- To evaluate the correlation between echocardiographic parameters of diastolic function and invasively measured left ventricular (LV) filling pressures in patients with Takotsubo cardiomyopathy (TC).
- To assess the accuracy of noninvasive echocardiographic methods in characterizing LV filling pressures in TC.
Main Methods:
- Echocardiography and cardiac catheterization were performed within 24 hours in 51 TC patients.
- Left ventricular (LV) end-diastolic pressure and LV pre-A diastolic pressure were obtained via catheterization.
- Echocardiographic parameters, including E/e' ratio and calculated mean left atrial pressure (mLAP), were analyzed.
Main Results:
- Echocardiographic parameters (E/e' ratio, mLAP) showed fair to moderate positive correlation with catheterization-derived LV pre-A pressure (r range, 0.38-0.44).
- Calculated mLAP demonstrated inconsistent agreement with invasive LV pre-A pressure (mean difference 0.77 ± 7.34 mm Hg).
- mLAP had poor diagnostic ability to identify elevated LV pre-A pressure (AUC 0.69).
Conclusions:
- Common echocardiographic parameters for diastolic function exhibit suboptimal correlation and diagnostic accuracy compared to invasive measurements in TC.
- Accurate characterization of LV filling pressures in TC using current noninvasive echocardiography is challenging.
- Invasive measurement of filling pressures should be considered the gold standard for risk stratification and management in TC.
Background:
The extent of diastolic dysfunction is of clinical importance in the risk stratification and management of patients with Takotsubo cardiomyopathy (TC). Standard echocardiographic indices of diastolic dysfunction have robust predictive ability in assorted disease states, but have not been validated in TC. The aim of this study was to compare Doppler metrics of diastolic function against catheterization-measured filling pressures in TC.
Methods:
Patients with TC who met inclusion and exclusion criteria were evaluated using echocardiography and catheterization performed within 24 hours. Both left ventricular (LV) end-diastolic pressure and LV pre-A diastolic pressure were obtained from catheterization tracings. The echocardiographic parameters for diastolic function were extracted using the American Society of Echocardiography recommendations and a previously validated regression equation for mean left atrial pressure (mLAP).
Results:
A total of 51 patients with TC were included. Patients were predominantly women (72.5%), with a mean age of 58 ± 13 years and a mean ejection fraction of 24 ± 10 %. E/e' ratio (septal, average, and lateral) and calculated mLAP correlated positively with catheterization LV pre-A, with fair to moderate correlation (coefficient range, 0.38-0.44). The t-test mean difference between LV pre-A pressure and calculated mLAP was 0.77 ± 7.34 mm Hg (95% CI, ±14.68 mm Hg) suggesting inconsistent measures. mLAP also exhibited poor diagnostic ability to discriminate elevated LV pre-A diastolic pressure, with an area under the receiver operating characteristic curve of 0.69 (95% CI, 0.50-0.88).
Conclusions:
Commonly used echocardiographic parameters for diastolic function demonstrated less-than-optimal correlation, with poor sensitivity and specificity, compared with invasively measured LV end-diastolic pressure or LV pre-A wave diastolic pressure in patients with TC. Precise characterization of LV filling pressure in patients with TC using contemporary noninvasive echocardiographic parameters appears challenging. Invasive measurements of filling pressure should remain the gold standard for optimal risk stratification and management of patients with TC.
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