Title : Echocardiographic assessment of left ventricular filling pressures using data from invasive left ventricular filling pressures in patients with normal left ventricular ejection fraction
Objectives: 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.