Left Atrial Distensibility and E/e' for Estimating Left Ventricular Filling Pressure in Patients With Stable Angina - A Comparative Echocardiography and Catheterization Study -

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp iastolic dysfunction has a significant impact on prognosis in a wide range of cardiac disorders. 1 Noninvasive methods of estimating left ventricular filling pressure (LVFP) are often helpful for diagnosing and treating diastolic heart failure. Some echocardiographic parameters associated with left ventricular (LV) diastolic function, such as mitral inflow velocities, deceleration time, and pulmonary venous flow velocities, are significantly influenced by preload. 2,3 Tissue Doppler imaging (TDI) is relatively preload independent, 4,5 and E/e' (the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity) has been proposed to provide a non-invasive measure of LVFP. 6 However, TDI was developed to assess regional function, 7-12 and its value for estimating global diastolic function in coronary artery disease (CAD) with regional function abnormalities is by implication limited. Thus, the application of E/e' for estimating LVFP might be more appropriate for patients with global LV dysfunction. Our previous report 13 indicated that left atrial (LA) distensibility correlates logarithmically with LVFP in patients with severe mitral regurgitation. It was the first comparative echocardiographic-catheterization study to demonstrate the correlation between a LA volume parameter and LVFP. We hypothesized that LA distensibility could become an indicator of global diastolic function and might be useful for assessing LVFP not only in patients with mitral regurgitation but also in those with stable angina. Thus, we analyzed the relationship between LA volume parameters and LVFP in CAD patients with stable angina and performed a head-to-head comparison of those 2 parameters (E/e' and LA volume parameter) for the accuracy of assessing LVFP Background: Although E/e' (the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity) is widely used to measure left ventricular filling pressure (LVFP), its accuracy is questionable in coronary artery disease patients.

Left Atrial Expansion Index Predicts Atrial Fibrillation in Dyspnea

“…Regarding the prognostic effect of LA expansion index described in prior studies [16][17][18][19][20] and the close correlation between LA expansion index and AF progression (Figure 1), it may be conjectured that structural rather than electrical remodeling of the atria is involved in AF progression. Underlying disease might cause chronic stretch and atrial dilation, which seem to be important stimuli for chronic atrial structural remodeling.…”

“…Recent work by the authors showed that the LA expansion index, which accurately reflects instantaneous LV filling pressure (logarithmic correlation) in many disease entities, is useful for predicting AF after coronary artery bypass graft surgery. [16][17][18][19][20] Because the LA expansion index mirrors LV filling pressure, we hypothesized that the LA expansion index predicts long-term events not only in patients with heart disease, but also in relatively low-risk subjects such as consecutive patients visiting cardiovascular clinics for dyspnea.…”

Prognostic Cardiovascular Markers in Chronic Kidney Disease

“…2D speckle-tracking echocardiography has been used to assess E'sr, and it also has been reported to be useful in assessing LV diastolic function [47]. The original purpose of E' was to evaluate regional diastolic function, and thus it is limited with regards to assessing global diastolic function with regional functional abnormalities [48]. Moreover, the inherent limitations of Dopplerbased assessments including the potential for significant errors in angle dependency with angulations > 20° may also limit the use of E' in assessing early diastolic function.…”

Comparison of Pressure–Volume Loop and Echocardiographic Measures of Diastolic Function in Patients With a Single-Ventricle Physiology

“…Therefore, it is difficult to know whether the lack of correlation is due to the characteristics of our patient population, or an insensitivity of EDP to identify early phase diastolic abnormalities. This is supported by multiple studies that have had mixed results when investigating the correlation of early diastolic echocardiographic measures to EDP [20, 25, 26]. …”