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October 24-25, 2019 | Tokyo, Japan

Jinchuan Yan

Speaker at Cardiology Conference 2019- Jinchuan Yan
Jinchuan Yan
Affiliated Hospital of Jiangsu University, China
Title : Echocardiographic assessment of left ventricular filling pressures using data from invasive left ventricular filling pressures in patients with normal left ventricular ejection fraction

Abstract:

The aims of this study were to assess the accuracy of multiple echo parameters of diastolic dynamics and the 2016 ASE/EACVI algorithm to detect elevated invasive LV diastolic pressures in patients with normal ejection fraction; the accuracy of the 2016 algorithm was compared to that of  a newly derived algorithm. 
Background Echocardiographic assessment of left ventricular (LV) diastolic function is an integral part of the routine examination. Simultaneous measurements of LV pressures and echocardiographic parameters are sparse.
Methods Patients (n=120) underwent left heart catheterization and coronary angiography for chest pain due to suspected coronary artery disease. Transthoracic echocardiography and LV pressure recordings were simultaneous. Receiver-operating characteristic curves were constructed to define optimal cut points for multiple echocardiographic parameters. Five were selected for new algorithm to estimate LV diastolic pressures: velocity of tricuspid regurgitation (> 280cm/s), average e´ (Av e´< 9), average E/e´ ratio (AvE/e’>13), velocity of pulmonary vein A wave reversal (PV ArV > 32 cm/s) and left atrial volume index (LAVi >32 ml/m2). The accuracy of the algorithm was examined for a LV pre-A >12 mmHg and LV end diastolic pressure (LVEDP) i.e. post-A >15 mmHg. 
Results All patients had a normal LV ejection fraction. Individual echocardiographic parameters of diastolic function (n=12) had moderate diagnostic utility. Using the algorithm of the 2016 guidelines, an elevated LVEDP >15 mmHg was identified with an accuracy of 69.1% (60.1-77.3); the newly derived algorithm that utilized the 5 echocardiographic variables had an accuracy of 84.2% (76.4-90.2), p <0.001.
Conclusions Simultaneous recordings of LV diastolic parameters and invasive LV pressures in a homogenous cohort confirmed that no single echocardiographic parameter can accurately assess LV diastolic pressures. Importantly, left ventricular diastolic pressures in patients with a normal LVEF were fairly reliably assessed by the 2016 guidelines. The new algorithm improved the accuracy of detecting abnormal LV filling pressures.

Audience take away:

  • Simultaneous recordings of LV diastolic parameters and invasive LV pressures in a homogenous cohort confirmed that no single echocardiographic parameter can accurately assess LV diastolic pressures.  The new algorithm improved the accuracy of detecting abnormal LV filling pressures.
  • All patients had a normal LV ejection fraction. Individual echocardiographic parameters of diastolic function (n=12) had moderate diagnostic utility. Using the algorithm of the 2016 guidelines, an elevated LVEDP >15 mmHg was identified with an accuracy of 69.1% (60.1-77.3); the newly derived algorithm that utilized the 5 echocardiographic variables had an accuracy of 84.2% (76.4-90.2).

Biography:

Dr. Yan received his PhD degree from the Fourth Military Medical University of China in cardiology. He works in the Affiliated Hospital of Jiangsu University, director of Cardiology department. Dr. Yan is Leader of national key clinical specialty disciplines. He has published more than 80 research articles in SCI (E) journals.