New Parameter Derived from Three-Dimensional Speckle-Tracking Echocardiography for the Estimation of Left Ventricular Filling Pressure in Nondilated Hearts

• Published in: Journal of the American Society of Echocardiography Vol. 30; no. 5; pp. 522 - 531
• Main Authors: Sakurai, Daisuke, MSc, Asanuma, Toshihiko, MD, PhD, Masuda, Kasumi, PhD, Koriyama, Hikaru, MSc, Nakatani, Satoshi, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Animals; Blood Pressure; Blood Pressure Determination - methods; Cardiovascular; Dogs; E/e; Echocardiography, Three-Dimensional - methods; Elasticity Imaging Techniques - methods; Filling pressure; Image Interpretation, Computer-Assisted - methods; Reproducibility of Results; Sensitivity and Specificity; Speckle-tracking echocardiography; Stroke Volume; Three-dimensional; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Early filling rate; Filling pressure; Mitral E; Left ventricular; Time derivative of the left ventricular volume curve; Mitral A; Tau; LV; Early diastolic strain rate; HFpEF; Mitral inflow late diastolic velocity; AUC; Speckle-tracking echocardiography; Circumferential early diastolic strain rate; Area under the curve; FRe; C-SRe; E/e; Left anterior descending artery; Heart failure with preserved ejection fraction; L-SRe; dV/dt; ROC; SRe; ICC; Longitudinal early diastolic strain rate; Mitral inflow early diastolic velocity; Time constant of left ventricular relaxation; LAD; Mitral annular early diastolic velocity; 3D; A-SRe; Three-dimensional; Receiver operating characteristic; Area early diastolic strain rate; Intra-class correlation coefficient
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2017.01.015

Background E/e′ is clinically useful for the noninvasive assessment of left ventricular (LV) filling pressure. However, its use in some conditions is controversial, and angle dependence of the Doppler measurement and preload dependence of mitral e′ in nondilated hearts represent major problems. The ratio of early filling rate derived from the time derivative of LV volume to early diastolic strain rate (FRe/SRe), similar to E/e′, by three-dimensional (3D) speckle-tracking echocardiography has the potential to address such limitations. This study investigated whether FRe/SRe could estimate acute changes in LV filling pressure using the models of volume overload and myocardial ischemia in the nondilated heart. Methods In 25 dogs, hemodynamic conditions were varied by acute volume overload and coronary occlusion. FRe and SRe were obtained from the same beat and automatically analyzed by the 3D speckle-tracking method, and global SRe was measured from longitudinal (L-SRe), circumferential (C-SRe), and area strain rate (A-SRe). E/e′ was measured by two-dimensional echocardiography. LV pressure was derived from a micromanometer catheter and recorded simultaneously with the acquisition of the 3D images. Results Mitral e′ and L-SRe varied by changes in preload, whereas C-SRe and A-SRe did not. C-SRe and A-SRe were more strongly correlated with the time constant of LV relaxation than mitral e′ and L-SRe. FRe/C-SRe and FRe/A-SRe had relatively high correlations with LV preatrial contraction (pre-A) pressure and end-diastolic pressure, but E/e′ and FRe/L-SRe did not. Receiver operating characteristics curve analysis showed that FRe/C-SRe and FRe/A-SRe had larger areas under the curve for the estimation of increased LV filling pressure. Conclusions The novel parameter FRe/SRe has potential as a surrogate marker of LV filling pressure. Especially in nondilated hearts, FRe/C-SRe and FRe/A-SRe may be useful to more accurately predict LV filling pressure than E/e′, although their applicability in dilated hearts requires further investigation.