Author + information
- Rahul Vasudev,
- Upamanyu Rampal,
- Hiten Patel,
- Kunal Patel,
- Raja Pullatt,
- Mahesh Bikkina and
- Fayez Shamoon
Background: Over the years many non-invasive methods for prediction of elevated left ventricular end diastolic pressure (LVEDP) have attracted attention. The aim of this study is to see the correlation between a new non-invasively obtained parameter- Left Atrial Volume Index Over Late Diastolic Mitral Annular Velocity (LAVi/A') and LVEDP (measured invasively) and see how it performs as compared to E/e’ in predicting LVEDP.
Methods: We retrospectively reviewed 80 consecutive echocardiographs of patients with simultaneous invasive measurement of LVEDP within 24 hours of each other. Invasive measurements of LVEDP were obtained using a fluid filled catheter placed in the left ventricle. Tissue Doppler was obtained from lateral mitral annular location to obtain late mitral diastolic velocity (A'). The calculated left atrial indexed volume (LAVi), was divided by A’ to obtain the novel non-invasive surrogate (LAVi/A') for estimation of LVEDP. The ratio of E/e’ was calculated in standard fashion using measurements obtained from pulsed (E) and tissue doppler (e') of Mitral valve.
Results: On the receiver operation characteristic curve analysis (ROC), the area under the curves of LAVi/A’ was comparable to E/e’ (63.4 % vs. 63.9, p >0.5). A LAVi/A’ of 2.1 was the best cut-off value to identify an elevated LVEDP (>15 mm of Hg). LAVi/A’ ≥ 2.1 was an independent predictor of an elevated LVEDP (2.824 odds ratio; 95% CI, 1.025, 7.776; P = 0.041). The sensitivity and specificity at LAVi / A ‘to detect an elevated LVEDP using a value of 2.1 was 80% and 41.4% respectively. The novel parameter of LAVi/A’ could predict LVEDP by using the equation: LVEDP =15.28 + 0.863*LAVI/A’ + Error term
On the other hand, using the standard cutoff of > 8 for E/E’ to identify increased LVEDP. E/E’ > 8 was also an independent predictor of elevated LVEDP (2.312 odds ratio; 95% CI, 0.879, 6.081; P = 0.086). The sensitivity and specificity of E/e ‘ to identify an elevated LVEDP was 74 % and 44.8% respectively.
Conclusions: The novel Non-invasive Echocardiographic Index of (LAVi/A') showed good correlation with invasively measured LVEDP and performed better than previously studied parameter of E/e’ with a higher sensitivity in our patient cohort.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: New Technologies in Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1245-209
- 2017 American College of Cardiology Foundation