Author + information
- Himanshu Gupta,
- Oleg F. Sharifov,
- Chun S. Schiros,
- Inmaculada Aban,
- Gilbert Perry,
- Louis J. Dell'italia and
- Thomas Denney
Background: Diagnostic accuracy of echocardiography for evaluating diastolic dysfunction is limited in preserved left ventricular ejection fraction (LVEF). We previously proposed the relationship of normalized rate of change in LV torsion shear angle (φ’) to corresponding rate of change in LV volume (V’) during early diastole (represented as -dφ’/dV’) as a measure of LV diastolic function. We prospectively evaluated diagnostic accuracy of -dφ’/dV’ with high fidelity invasive LV parameters and compared with echocardiography.
Methods: Participants (n=36, age 61±7 years) with LVEF ≥50% and no acute myocardial infarction undergoing coronary angiography but no primary coronary intervention for chest pain and dyspnea evaluation were studied. High fidelity LV pressure measurements were performed at baseline and after sublingual nitroglycerin to obtain LV end diastolic pressure (LVEDP) and Tau, time constant of LV diastolic relaxation. Definite diastolic dysfunction (LVDD) was defined as LVEDP >12 mmHg and Tau >48 ms. Cardiac magnetic resonance imaging (CMR) with tissue tagging and echocardiography was performed.
Results: Mean LVEDP was 14.5±5.5 mmHg (mean±SD) and Tau was 58±10 ms. CMR derived -dφ’/dV’ was 5.6±3.7. -dφ’/dV’ correlated with both LVEDP and Tau (r=0.36 and 0.39 respectively, P<0.05) and was significantly higher for LVEDP >12 mmHg and Tau >48 ms respectively. Area under the curve (AUC) of -dφ’/dV’ for estimating Tau >48 ms and LVEDP >12 mmHg was 0.83 (0.67-0.98, P=0.001) with sensitivity of 72% and specificity 100% for dφ’/dV’ ≥6.2. Multiple regression showed that -dφ’/dV’ was the most important parameter for diagnosing LVDD. Echocardiographic parameters were of limited use for LVDD identification. There were good limits of agreement between pre and post nitroglycerin -dφ’/dV’.
Conclusions: -dφ’/dV’ obtained from LV torsion volume loop is a promising parameter for assessing LV diastolic dysfunction in preserved LVEF that requires further evaluation.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Non Invasive Imaging: MR Characterization and Function
Abstract Category: 29. Non Invasive Imaging: MR
Presentation Number: 1118-210
- 2017 American College of Cardiology Foundation