Clinical Significance of Abnormal Relaxation Pattern of the Transmitral Flow Velocity Waveform in Older Patients With Preserved Left Ventricular Ejection Fraction

Kikuchi, Shohei; Wakami, Kazuaki; Goto, Toshihiko; Fukuta, Hidekatsu; Sonoda, Hiroo; Tani, Tohru; Ohte, Nobuyuki

doi:10.1253/circj.cj-13-0426

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…Before contrast material was injected into the left ventricle or coronary arteries, LV pressure ( P ) waves were obtained with a catheter-tipped micromanometer (SPC-454D, Millar Instrument Co., Houston, TX) and recorded on a polygraph system (RMC-3000; Nihon Kohden Inc., Tokyo, Japan) as analog P signals. The P signals were sent to a digital data recorder (NR-2000, Keyence, Osaka, Japan) at a sampling interval of 2 ms, as we have reported elsewhere [ 3 , 4 , 8 , 16 , 17 ]. d P /d t was obtained by differentiating digitally the LV P with respect to time, and peak (−d P /d t ) was defined as the maximum negative value of d P /d t .…”

Section: Methodsmentioning

confidence: 99%

Patients with left ventricular ejection fraction greater than 58 % have fewer incidences of future acute decompensated heart failure admission and all-cause mortality

et al. 2015

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Based on our previous observation, inertia stress (IS) of late systolic aortic flow was often observed in left ventricles with relatively higher left ventricular (LV) ejection fraction (EF). Most left ventricles with relatively lower LVEF did not have IS. Accordingly, lack of IS may correlate with LV diastolic dysfunction through the loss of LV elastic recoil and may contribute to the pathogenesis of heart failure (HF) and reduced survival. We enrolled 144 consecutive patients that underwent cardiac catheterization for the diagnosis of coronary artery disease. Left ventricular ejection fraction (LVEF) was obtained from left ventriculography. The IS was calculated from the LV pressure (P)−dP/dt relation. The study endpoint of this retrospective outcome-observational study was combined subsequent acute decompensated heart failure (ADHF) and all-cause mortality. During the follow-up period (median 6.1 years), seven unscheduled hospitalizations for ADHF and nine all-cause deaths were observed. The event-free survival rate was significantly higher among patients with IS than among patients without IS (log-rank, p = 0.001). On a multivariate Cox regression analysis, lack of IS was a prime predictor of the endpoint during follow-up (hazard ratio: 6.98; 95 % confidence interval: 1.48–33.03; p = 0.01). An LVEF ≥ 58 % was a surrogate indicator for the presence of IS, and patients with LVEF ≥ 58 % had fewer incidences of the endpoint than patients with LVEF < 58 %. In conclusion, lack of IS or LVEF < 58 % should be a predictor of future ADHF and all-cause mortality.Electronic supplementary materialThe online version of this article (doi:10.1007/s00380-015-0657-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Patients with left ventricular ejection fraction greater than 58 % have fewer incidences of future acute decompensated heart failure admission and all-cause mortality

et al. 2015

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“…We previously reported that the correlation between τ and e' was significant but weak in patients with LVEF ≥50%. 19 An increase in E/e', LA volume index, or TR velocity essentially reflects an elevation of LV filling pressure; 20-22 thus, we additionally examined whether algorithm A could identify patients with elevated LV pre-A pressure (a surrogate of LV filling pressure). As predicted, algorithm A detected an elevated LV pre-A pressure, even in this study cohort with preserved LVEF, with improved diagnostic accuracy compared with a lengthened τ and/or increased LVEDP.…”

Section: Discussionmentioning

confidence: 99%

Verification of Echocardiographic Assessment of Left Ventricular Diastolic Dysfunction in Patients With Preserved Left Ventricular Ejection Fraction Using the American Society of Echocardiography and European Association of Cardiovascular Imaging 2016 Recommendations

et al. 2019

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Background: Non-invasive evaluation of left ventricular (LV) diastolic dysfunction (DD) and elevated LV filling pressure are crucial for diagnosing heart failure. The 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/ EACVI) recommendations for evaluating elevated LV filling pressure (algorithm B) have acceptable diagnostic accuracy, including in patients with reduced LV ejection fraction (EF). No prior study, however, has assessed the diagnostic accuracy of algorithm A of the ASE/EACVI recommendations for evaluating LVDD in patients with normal LVEF. Methods and Results: We evaluated the clinical relevance of algorithm A in 94 patients who underwent invasive LV pressure measurement. Algorithm A identified invasively defined LVDD (time constant τ≥48 ms and/or LV end-diastolic pressure ≥16 mmHg) with low sensitivity (22.4%) but high specificity (90.7%). Algorithm A also identified elevated LV filling pressure with low sensitivity (41.7%) but high specificity (87.5%), and with a high negative predictive value (90.9%). Conclusions: Algorithm A may not be useful for screening LVDD in patients with normal LVEF. Negative findings using algorithm A, however, may identify a patient with normal LVDD with high specificity, and most of such patients will have LV pre-A pressure in the normal range.

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Left Ventricular Ejection Fraction (EF) of 55% as Cutoff for Late Transition From Heart Failure (HF) With Preserved EF to HF With Mildly Reduced EF

Ueda

Kawakami

Nishida

et al. 2015

Circ J

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Background: Heart failure (HF) with preserved (HFpEF) left ventricular ejection fraction (LVEF) is a syndrome with complex pathophysiology. Little is known about changes in LVEF that occur over time in HFpEF patients. A fundamental clinical question about HFpEF is whether HFpEF is an early manifestation of HF with reduced LVEF (HFrEF). If so, which patients with HFpEF are likely to show a decline in LVEF to less than 50%? The aim of the present study was to examine longitudinal changes in LVEF in patients with HFpEF. Methods and Results:Among 279 consecutive HFpEF patients admitted as emergencies, we examined 100 who underwent echocardiography at least 1 year after discharge. EF >50% was used as the definition of HFpEF. During a mean duration from hospitalization to follow-up echocardiography of 31.5 months, 11% of patients had LVEF ≤50% (mildly reduced LVEF), known as mildly reduced (HFmrEF). The utility of LVEF during hospitalization to predict HFmrEF was assessed with receiver-operating characteristic curve analysis. A cutoff value of 55% had sensitivity of 90.9% and specificity of 97.7%. Logistic regression analysis indicated that LVEF ≤55% and ischemic etiology were strong predictors of progression from HFpEF to HFmrEF (odds ratio [OR] 435, 95% confidence interval [CI] 52.65-10,614, P<0.0001 and OR 10.9, 95% CI 2.60-74.80, P=0.0007, respectively). Conclusions:The present study suggests that HFpEF patients with LVEF ≤55% may progress to HFmrEF in the future. (Circ J 2015; 79: 2209 -2215

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Clinical Significance of Abnormal Relaxation Pattern of the Transmitral Flow Velocity Waveform in Older Patients With Preserved Left Ventricular Ejection Fraction

Cited by 4 publications

References 34 publications

Patients with left ventricular ejection fraction greater than 58 % have fewer incidences of future acute decompensated heart failure admission and all-cause mortality

Patients with left ventricular ejection fraction greater than 58 % have fewer incidences of future acute decompensated heart failure admission and all-cause mortality

Verification of Echocardiographic Assessment of Left Ventricular Diastolic Dysfunction in Patients With Preserved Left Ventricular Ejection Fraction Using the American Society of Echocardiography and European Association of Cardiovascular Imaging 2016 Recommendations

Left Ventricular Ejection Fraction (EF) of 55% as Cutoff for Late Transition From Heart Failure (HF) With Preserved EF to HF With Mildly Reduced EF

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