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E/e` ratio is superior to speckle tracking for detecting elevated left ventricular end‐diastolic pressure in patients with coronary artery disease and preserved ejection fraction
Author(s) -
Calvilho Júnior Antonio Amador,
Assef Jorge Eduardo,
Le Bihan David,
Barretto Rodrigo Bellio de Mattos,
Paladino Filho Antonio Tito,
Abizaid Alexandre Antônio Cunha,
Braga Sérgio Luiz Navarro,
Vilela Andrea de Andrade,
Pedra Simone Rolim Fernandes Fontes,
de Jesus Carlos Alberto
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14407
Subject(s) - preload , ejection fraction , cardiology , medicine , coronary artery disease , diastole , speckle tracking echocardiography , receiver operating characteristic , hemodynamics , blood pressure , heart failure
Background A weak correlation has been reported between left ventricular filling pressures and the traditional echocardiographic tools for the evaluation of diastolic function in patients with coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF). On the other hand, studies that compared invasive measurements with speckle tracking echocardiography have shown promising results, but they were not exclusively targeted on this specific population. Methods and Results Immediately before the left heart catheterization, a comprehensive two‐dimensional Doppler echocardiography and speckle tracking analysis was prospectively performed in outpatients referred for coronary angiography. Left ventricular end‐diastolic pressure (LVEDP) was measured before any contrast exposure. Eighty‐one patients with coronary artery disease were studied, and the group with high LVEDP (n = 40) showed increased left atrial volume index (22 ± 6 mL/m 2 vs 26 ± 8.26 mL/m 2 , P = 0.04), E‐wave velocity (65 ± 15 cm/s vs 78 ± 20 cm/s, P = 0.02), E/e` (average) ratio (8.14 ± 2.0 vs 11.54 ± 2.7, P = 0.03), and E/global circumferential strain rate E peak ratio (E/GCSR E ) (39 cm vs 46 cm, P < 0.01). There was a positive correlation between LVEDP and E/e` (ρ = 0.56; P = 0.03), and between LVEDP and E/GCSR E ratio (ρ = 0.43; P < 0.01). The area under the receiver operating characteristics (ROC) curve was 0.83 and 0.73, respectively ( P < 0.05). E/e` and E/GCSR E were both independent predictors of elevated LVEDP ( P < 0.05), with a higher C‐statistic for the model including E/e` (0.89 vs 0.85). Conclusion The E/e` ratio was able to identify elevated LVEDP in CAD patients with preserved LVEF with more accuracy than the E/GCSR E ratio.