Abstract 11873: Assessment of Rapid Change of Left Ventricular Filling Pressure Using a Novel Global Strain Imaging Diastolic Index

Abstract

Background: Non-invasive estimation of left ventricular (LV) filling pressure using the ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/e’) has been reported to have limited reliability in patients with decompensated heart failure. We aimed to examine whether our novel global strain imaging diastolic index (SIDI) obtained using 2D speckle tracking imaging (2DSI) could predict rapid change of LV filling pressure over nitrate.

Methods: Fifty-nine (age 62±12 years) with suspected coronary artery disease underwent echocardiography and 2DSI during simultaneous cardiac catheterization. LV pre-atrial contraction (Pre-AC) pressure was measured as a surrogate of LV filling pressure. Echocardiographic and catheter measurements were repeated 5 minutes after intravenous nitrate. SIDI was defined as LV longitudinal changes during the first one-third of diastolic duration as previously reported. In 2DSI, LV longitudinal SIDI of 18 LV segments were measured from the apical 2-, 3-, and 4-chamber views. Then, longitudinal global SIDI (L-global SIDI) was calculated as a mean SIDI of 18 LV segments. Mitral inflow and tissue Doppler imaging were also assessed.

Results: Pre-AC pressure was significantly reduced from 22±9 to 11±5 mmHg after intravenous nitrate. At baseline, both L-global SIDI and E/e’ had a significant a correlation with Pre-AC pressure (p<0.05, R=0.39, and p<0.05, R=0.35, respectively). After intravenous nitrate, L-global SIDI still had significant correlation with Pre-AC pressure (p<0.05, R=0.36), whereas E/e’ did not (p=0.09, R=0.22). In addition, the change ratio of L-global SIDI over nitrate significantly correlated with that of Pre-AC pressure over nitrate (p<0.01, R=0.42).

Conclusions: L-global SIDI derived from 2DSI may predict rapid change of LV filling pressure more accurately than E/e’. Global SIDI may be useful in noninvasive estimation of LV filling pressure in patients with decompensated heart failure.