Abstract 548: Non-Invasive Estimation of Left Ventricular Filling Pressures in Heart Failure Patients After Surgical Ventricular Restoration and Restrictive Mitral Annuloplasty
Objective: Doppler echocardiography including tissue Doppler imaging (TDI) is widely applied to assess diastolic left ventricular (LV) function using E/E′ as a non-invasive estimate of LV filling pressures. However, accuracy of E/E′ in heart failure patients, particularly after extensive cardiac surgery, is debated. Global diastolic strain rate during isovolumic relaxation (SRIVR) obtained with 2-dimensional speckle tracking analysis was recently proposed as an alternative approach to estimate LV filling pressures.
Methods: We analyzed diastolic function in heart failure patients after surgical ventricular restoration (SVR) and/or restrictive mitral annuloplasty (RMA). Echocardiography including TDI and speckle tracking analysis was performed to determine E/A, IVRT, DT, E/E′MEAN, SRIVR, and E/SRIVR. These non-invasive indices were correlated with relaxation time constant Tau, dP/dtMIN, and LV end-diastolic pressure (LVEDP) obtained in the catheterization room using high-fidelity pressure catheters.
Results: 23 patients were analyzed 6 months after RMA (n = 8), SVR (n = 4) or a combined procedure (n = 11). The strongest correlation with invasive indices, in particular LVEDP, was found for SRIVR (r =−0.76, p<0.001). E/E′MEAN did not correlate significantly with any of the invasive indices. SRIVR (cut-off value <0.38 s−1) accurately predicted LVEDP ≥16 mmHg with 100% sensitivity and 93% specificity.
Conclusions: In a group of heart failure patients investigated 6 months after cardiac surgery, E/E′MEAN correlated poorly with invasively obtained diastolic indexes. Global SRIVR, however, correlated well with LVEDP and dP/dtMIN. Our data suggest that global SRIVR is a promising non-invasive index to assess left ventricular filling pressures in heart failure patients after extensive cardiac surgery including RMA and SVR.