From the Cardiovascular Biophysics Laboratory, Cardiovascular Division (S.M., S.Z., S.J.K), Department of Physics (S.M., S.Z., S.J.K.), and Department of Medicine, Cardiovascular Division (S.J.K), Washington University School of Medicine, St. Louis, MO.
Circ Cardiovasc Imaging. 2015 Jan;8(1). doi: 10.1161/CIRCIMAGING.114.002177.
Pseudonormal Doppler E-wave filling patterns indicate diastolic dysfunction but are indistinguishable from the normal filling pattern. For accurate classification, maneuvers to alter load or to additionally measure peak E' are required. E-wave deceleration time (DT) has been fractionated into its stiffness (DTs) and relaxation (DTr) components (DT=DTs+DTr) by analyzing E-waves via the parametrized diastolic filling formalism. The method has been validated with DTs and DTr correlating with simultaneous catheterization-derived stiffness (dP/dV) and relaxation (τ) with r=0.82 and r=0.94, respectively. We hypothesize that DT fractionation can (1) distinguish between unblinded (E' known) normal versus pseudonormal age-matched groups with normal left ventricular ejection fraction, and (2) distinguish between blinded (E' unknown) normal versus pseudonormal groups, based solely on E-wave analysis.
Data (763 E-waves) from 15 age-matched, pseudonormal (elevated E/E') and 15 normal subjects were analyzed. Conventional echocardiographic and parametrized diastolic filling stiffness (k) and relaxation (c) parameters and DTs and DTr were compared. Conventional diastolic function parameters did not differentiate between unblinded groups, whereas k, c (P<0.001) and DTs, DTr (P<0.001) did. Independent, blinded (E' not provided) analysis of 42 subjects (30 subjects from unblinded training set and 12 additional subjects from validation set, 581 E-waves) showed that R (=DTr/DT) had high sensitivity (0.90) and specificity (0.86) in differentiating pseudonormal from normal once E' revealed actual classification.
arametrized diastolic filling-based E-wave analysis (k, c or DTs and DTr) can differentiate normal versus pseudonormal filling patterns without requiring knowledge of E'.
假性正常多普勒 E 波充盈模式表明舒张功能障碍，但与正常充盈模式无法区分。为了进行准确分类，需要改变负荷或另外测量峰值 E'的操作。通过参数化舒张充盈形式分析 E 波，E 波减速时间 (DT) 已被分为其僵硬 (DTs) 和松弛 (DTr) 分量 (DT=DTs+DTr)。该方法已通过 DTs 和 DTr 与同时导管衍生的僵硬 (dP/dV) 和松弛 (τ) 进行验证，相关系数分别为 r=0.82 和 r=0.94。我们假设 DT 分裂可以：(1) 在正常左心室射血分数的情况下，区分未盲（已知 E'）正常与假性正常年龄匹配组；(2) 仅基于 E 波分析，区分盲（未知 E'）正常与假性正常组。
分析了 15 例年龄匹配的假性正常（升高的 E/E'）和 15 例正常患者的 763 个 E 波数据。比较了常规超声心动图和参数化舒张充盈僵硬 (k) 和松弛 (c) 参数以及 DT 和 DTr。常规舒张功能参数无法区分未盲组，而 k、c（P<0.001）和 DT、DTr（P<0.001）可以区分。对 42 例患者（未盲训练组 30 例和验证组 12 例，581 个 E 波）进行独立的盲法（未提供 E'）分析显示，一旦 E'揭示了实际分类，R（=DTr/DT）在区分假性正常与正常方面具有高敏感性（0.90）和特异性（0.86）。
基于参数化舒张充盈的 E 波分析（k、c 或 DT 和 DTr）可以在不了解 E'的情况下区分正常与假性正常充盈模式。
