Early mitral inflow velocity to left ventricular global strain ratio predicts limited exercise capacity

Abstract

Background Estimation of left ventricular filling pressure (LVFP) is the essential part of the echocardiographic workup for exercise intolerance. The ratio of the mitral early filling velocity to the left ventricular global longitudinal strain (E/LVGLS) has emerged as a novel index of LVFP. This study aimed to investigate the relationship between E/LVGLS and exercise capacity. Methods and results We retrospectively reviewed 90 patients with exertional dyspnea who underwent echocardiography and cardiopulmonary exercise test. Patients were classified into three groups according to their percent‐predicted maximal oxygen consumption (ppVo2) (G ≧ 75, ppVo2 > 75%, n = 20; G 50‐75, ppVo2 75‐50%, n = 57; G < 50, ppVo2 < 50%, n = 13). Measurements were (a) the relationship between ppVo2 and E/LVGLS and (b) the efficiency of integrated diastolic assessment using E/LVGLS, left ventricular volume, mitral annular early diastolic velocity (E′), and tricuspid regurgitation to identify the patient with impaired exercise capacity. Univariate linear regression analysis demonstrated that E/LVGLS had significant correlation with ppVo2 (ρ = 0.52, P < 0.001). The area under the ROC of E/LVGLS for ppVo2 < 50% was 0.86 (95%CI 0.75‐0.97). The DeLong test showed that E/LVGLS was efficient to detect ppVo2 < 50% than E/E′ (P = 0.007). When used in the integrated assessment of LVFP as the alternative for E/E′, E/LVGLS improved risk classification for impaired exercise capacity. Conclusion E/LVGLS may be a more efficient index than E/E′ to identify exercise impairment as a single index and as a part of the integrated diastolic assessment.

Novel grading system for ischemia‒reperfusion injury manifestations in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

“…Echocardiography is a reliable method for visual assessment of segmental and global cardiac function 19 . Using Doppler tissue imaging (TDI) to measure the ratio of the early diastolic blood flow peak (E) and the early diastolic movement speed (e′) of the mitral valve cusp at the level of the mitral valve cusp, it can be simple, effective and noninvasive to evaluate the left ventricular filling pressure of the heart and diastolic function 20 , 21 . This study showed that the higher the MIRI manifestation grade is, the larger the LVEDD and E/e′ and the smaller the E/A.…”