Suleman Muhammad, Saqib Muhammad, Mumtaz Hassan, Iftikhar Muhammad, Raza Ali, Rauf Butt Samia, Talha Kenza Manahal
Peshawar Institute of Cardiology.
Khyber Medical College, Peshawar.
Ann Med Surg (Lond). 2023 Sep 13;85(11):5384-5395. doi: 10.1097/MS9.0000000000001287. eCollection 2023 Nov.
Heart failure with preserved ejection fraction is a complex clinical syndrome associated with a high level of morbidity and mortality, constituting 56% of heart failure cases and showing an increasing prevalence. The E/Ea ratio, used for echocardiographic assessment of left ventricular (LV) filling pressure, has been commonly recommended as a noninvasive measure. However, its validity lacks robust prospective validation in patients with preserved LV ejection fraction, and its accuracy has been questioned in comparison to patients with reduced LV ejection fraction. The objective of this study was to evaluate the accuracy of novel echocardiographic markers incorporating peak E velocity, left atrial volume index (LAVi), and pulmonary artery systolic pressure (PAP) for noninvasive estimation of LV end-diastolic pressure (LVEDP) against invasive measurement. In this cross-sectional study conducted at a tertiary care hospital, a sample size of 122 participants was utilized. Statistical analyses including independent samples -test, χ test, and linear regression analysis were employed to explore correlations and predict outcomes. The results indicated that Group 1 (LVEDP <20 mmHg) had a mean age of 59.25 years, while Group 2 (LVEDP >20 mmHg) had a mean age of 56.93 years. Mitral E velocity positively predicted LVEDP, while Mitral E/A ratio showed a negative association. Notably, (E+PAP)/2, (E+LAVi)/2, and Mitral E exhibited good discriminative ability, with respective area under the curve values of 0.840, 0.900, and 0.854. (E+LAVi)/2 demonstrated the highest discriminatory power, with a threshold of 40.100, yielding high sensitivity (0.971) but relatively low specificity (0.302) in predicting LVEDP greater than 20. These findings emphasize the accuracy and utility of combining diastolic variables and peak E velocity as markers for left ventricular filling pressure in patients with a high burden of cardiac disease. Additionally, the study highlights the importance of these parameters in assessing cardiac abnormalities and supports the potential of novel echocardiographic parameters, particularly (E+LAVi)/2, in predicting LVEDP greater than 20. Further research is warranted to validate and explore the prognostic implications of these parameters in larger patient populations, ultimately improving the diagnosis and management of cardiac disease and enhancing clinical outcomes.
射血分数保留的心力衰竭是一种复杂的临床综合征，发病率和死亡率高，占心力衰竭病例的56%，且患病率呈上升趋势。用于超声心动图评估左心室（LV）充盈压的E/Ea比值，一直被普遍推荐作为一种非侵入性测量方法。然而，其有效性在射血分数保留的患者中缺乏有力的前瞻性验证，与射血分数降低的患者相比，其准确性也受到质疑。本研究的目的是评估结合E峰速度、左心房容积指数（LAVi）和肺动脉收缩压（PAP）的新型超声心动图标志物对LV舒张末期压力（LVEDP）进行无创估计相对于有创测量的准确性。在一家三级医疗中心进行的这项横断面研究中，使用了122名参与者的样本量。采用包括独立样本t检验、χ检验和线性回归分析在内的统计分析方法来探索相关性并预测结果。结果表明，第1组（LVEDP<20 mmHg）的平均年龄为59.25岁，而第2组（LVEDP>20 mmHg）的平均年龄为56.93岁。二尖瓣E峰速度正向预测LVEDP，而二尖瓣E/A比值呈负相关。值得注意的是，(E+PAP)/2、(E+LAVi)/2和二尖瓣E表现出良好的鉴别能力，曲线下面积值分别为0.840、0.900和0.854。(E+LAVi)/2表现出最高的鉴别能力，阈值为40.100，在预测LVEDP大于20时具有高敏感性（0.971）但相对低特异性（0.302）。这些发现强调了将舒张期变量和E峰速度结合作为心脏病负担较重患者左心室充盈压标志物的准确性和实用性。此外，该研究突出了这些参数在评估心脏异常中的重要性，并支持新型超声心动图参数，特别是(E+LAVi)/2，在预测LVEDP大于20方面的潜力。有必要进行进一步研究以在更大患者群体中验证和探索这些参数的预后意义，最终改善心脏病的诊断和管理并提高临床结局。
