Estimating Left Ventricular Filling Pressure by Echocardiography

Andersen, O.; Smiseth, Otto A.; Dokainish, Hisham; Abudiab, Muaz M.; Schutt, Robert C.; Kumar, Arnav; Sato, Kimi; Harb, Serge C.; Gude, Einar; Remme, Espen W.; Andreassen, Arne K.; Ha, Jong Won; Xu, Jiaqiong; Klein, Allan L.; Nagueh, Sherif F.

doi:10.1016/j.jacc.2017.01.058

Cited by 349 publications

(309 citation statements)

References 28 publications

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“…A recent study comparing the correlation between E/e′ ratio, LAVI, and LVFP found that correlation of the LAVI with LVFP (r=0.23) was weaker than that of E/e′ (r=0.65). 41 In addition, the measurement of LAVI may be inaccurate in patients with atrial fibrillation (15% incidence in our study sample). An inaccurately measured LAVI would not correlate with LVFP and therefore the association between LAVI and postoperative AKI may be weakened.…”

Section: Discussionmentioning

confidence: 74%

“…For this validation, a recent multicenter study evaluated the accuracy of estimating LVFP by echocardiography. 41 In their results, an average E/e′ ratio was modestly correlated with invasively measured LVFP (r=0.65). The accuracy of diagnosis of elevated filling pressure by echocardiographic index was good, with an overall accuracy of 87%, although the accuracy was less reliable with normal EF (84%) compared with 91% with a decreased EF.…”

Section: Discussionmentioning

confidence: 87%

“…In addition to E/e′, other echocardiographic parameters that are associated with increased LVFP should be considered. 14, 41 The LAVI, although known to reflect chronically elevated filling pressures and being related to E/e′, could be associated with postoperative AKI. High LVFP is also associated with increased LVMI, which may also be related to postoperative AKI.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Hur

Nam

et al. 2018

Circ J

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and mortality. 4,9 Hemodynamic disturbance during OPCAB has been reported to have a biventricular contribution, and the major cause is believed to be diastolic dysfunction and abnormal filling of both ventricles. 10,11 As such, it is possible that an underlying increased LVFP may aggravate the intraoperative hemodynamic disturbance, resulting in a higher rate of postoperative AKI. Although previous studies have reported the effect of diastolic dysfunction on postoperative outcomes, including death or major adverse cardiac events (MACE), 4,12 postoperative renal dysfunction was evaluated only as a secondary outcome and the association between increased LVFP in patients with normal LV systolic function and postoperative AKI has not been fully evaluated.The ratio of the early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e′) has been reported to have good predictive power for mean LV diastolic pressure or mean LVFP and has been used to estimate the diastolic function of the heart. 13,14 E/e′ >15 is P erioperative acute kidney injury (AKI) has been reported to be an important contributor to postoperative morbidity and mortality especially after cardiovascular surgery, including coronary artery bypass graft (CABG). 1,2 Off-pump coronary artery bypass surgery (OPCAB) has been associated with less severe and a lower incidence of AKI compared with on-pump CABG. 3 Nonetheless, there is still a substantial incidence of AKI after OPCAB and it is caused by transient circulatory arrest, global hypoperfusion, myocardial ischemia-reperfusion injury, and inflammatory response. 3 The incidence of diastolic dysfunction in patients who undergo CABG has been reported as high. 4,5 Although many studies have reported systolic dysfunction of the heart as a risk factor for postoperative AKI, 6,7 the association between preoperative diastolic dysfunction and postoperative AKI has not been investigated. A stiff left ventricle with low compliance would lead to an elevated LV filling pressure (LVFP), 8 which is associated with higher morbidity Background: The ratio of the early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e′) is an echocardiographic index of mean left ventricular (LV) filling pressure. We investigated the association between the preoperative E/e′ ratio and postoperative acute kidney injury (AKI) during off-pump coronary artery bypass surgery (OPCAB).

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Hur

Nam

et al. 2018

Circ J

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“…Two recent multicenter studies compared echocardiographic estimates of LV filling pressures against invasive measurements by cardiac catheterization and reported high feasibility and good accuracy irrespective of LV function, especially when combined with clinical data. 6,7 These studies were performed by investigators who constituted the core of the guidelines writing group and have extensive specific expertise in the evaluation of diastolic function by echocardiography.…”

mentioning

confidence: 99%

Invasive Validation of the Echocardiographic Assessment of Left Ventricular Filling Pressures Using the 2016 Diastolic Guidelines: Head-to-Head Comparison with the 2009 Guidelines

Balaney

Medvedofsky

Mediratta

et al. 2018

Journal of the American Society of Echocardiography

119

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Background Recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines for echocardiographic evaluation of left ventricular (LV) diastolic function provide a practical, simplified diagnostic algorithm for estimating LV filling pressure. The aim of this study was to test the accuracy of this algorithm against invasively measured pressures and compare it with the accuracy of the previous 2009 guidelines in the same patient cohort. Methods Ninety patients underwent transthoracic echocardiography immediately before left heart catheterization. Mitral inflow E/A ratio, E/e′, tricuspid regurgitation velocity, and left atrial volume index were used to estimate LV filling pressure as normal or elevated using the ASE/EACVI algorithm. Invasive LV pre-A pressure was used as a reference, with >12 mm Hg defined as elevated. Results Invasive LV pre-A pressure was elevated in 40 (44%) and normal in 50 (56%) patients. The 2016 algorithm resulted in classification of 9 of 90 patients (10%) as indeterminate but estimated LV filling pressures in agreement with the invasive reference in 61 of 81 patients (75%), with sensitivity of 0.69 and specificity of 0.81. The 2009 algorithm could not definitively classify 4 of 90 patients (4.4%), but estimated LV filling pressures in agreement with the invasive reference in 64 of 86 patients (74%), with sensitivity of 0.79 and specificity of 0.70. Conclusions The 2016 ASE/EACVI guidelines for estimation of filling pressures are more user friendly and efficient than the 2009 guidelines and provide accurate estimates of LV filling pressure in the majority of patients when compared with invasive measurements. The simplicity of the new algorithm did not compromise its accuracy and is likely to encourage its incorporation into clinical decision making.

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“…17 We thus speculate that any factors could have altered the relationship between LVMDP and E/e′, as between τ and e′, which we have already stated. Accordingly, we tested the determinants of E/e′ and found that not only LVMDP but also LVMI were independent determinant of E/e′.…”

Section: Advance Publication By-j-stagementioning

confidence: 51%

Left Ventricular Mass Influences Relationship Between Filling Pressure and Early-Diastolic Ratio of Inflow Velocity to Mitral Annular Velocity (E/e′)

Nakabachi

Yamada

Iwano

et al. 2018

Circ J

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hypertrophic cardiomyopathy (HCM) 6 and those with severe LV dysfunction. 7 We also have reported that e′ significantly but only weakly correlated with the time constant of LV pressure decay (τ) and that E/e′ modestly correlated with filling pressure in a multicenter study in Japan (strain/strain rate vs. myocardial velocity for assessing left ventricular relaxation and filling pressure: SMAP study). 8 Accordingly, we speculated that some characteristics of the subjects in the SMAP study had altered the relationships between τ and e′ and between LV filling pressure and E/e′, and we conducted a substudy of SMAP. Because HCM itself has idiosyncratic features associated with LV T he tissue Doppler-derived early-diastolic mitral annular velocity (e′) and the ratio of early-diastolic left ventricular (LV) inflow velocity (E) to e′ (E/e′) reflect LV relaxation and filling pressure, respectively. 1-3 It is recommended that e′ and E/e′ should not be used for the estimation of LV relaxation and filling pressure in normal subjects, or patients with significant mitral annular calcification, surgical rings, mitral stenosis, prosthetic mitral valves, moderate to severe primary mitral regurgitation, or constrictive pericarditis. Background: Early-diastolic mitral annular velocity (e′) and the ratio of early-diastolic left ventricular (LV) inflow velocity (E) to e′ (E/e′) have been widely used as indexes of LV relaxation and filling pressure, respectively. However, many recent studies have demonstrated that they are not reliable in various clinical settings. We thus investigated the factors influencing these echocardiographic parameters in a multicenter study.

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Estimating Left Ventricular Filling Pressure by Echocardiography

Abstract: Echocardiographic assessment of LV filling pressure is feasible and accurate. When combined with clinical data, it leads to a more accurate diagnosis, regardless of LVEF.

Cited by 349 publications

References 28 publications

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Association Between Elevated Echocardiographic Index of Left Ventricular Filling Pressure and Acute Kidney Injury After Off-Pump Coronary Artery Surgery

Invasive Validation of the Echocardiographic Assessment of Left Ventricular Filling Pressures Using the 2016 Diastolic Guidelines: Head-to-Head Comparison with the 2009 Guidelines

Left Ventricular Mass Influences Relationship Between Filling Pressure and Early-Diastolic Ratio of Inflow Velocity to Mitral Annular Velocity (E/e′)

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