Abstract 16013: The Estimation of End-Diastolic Pressure by Echocardiography in Transplant Patients

Abstract

Background: American Society of Echocardiography and European Association of Echocardiography (ASE/EAE) have proposed a multiparametric algorithm to predict left ventricular (LV) end-diastolic pressures (EDP). We evaluated the ability of diastolic parameters used in the ASE/EAE algorithm to predict EDP in patients post heart transplantation.

Methods and Results: We assessed 53 consecutive transplant patients (40 men, age 57±11 yrs, EF 50±33 %) in whom echocardiography and invasive LV systolic (SBP) and EDP measurement were performed within 24 hours. Early diastolic to atrial wave velocity ratio of the mitral inflow (E/A), early diastolic velocity of mitral annulus measured at its septal and lateral side and averaged (e’), isovolumic relaxation time (IVRT), left atrial volume index (LAVI), right ventricular systolic pressure (RVSP), time interval between the onset of early diastolic velocities at mitral annulus and mitral inflow (Tea-Te’), and time constant of isovolumic pressure decay (tau; calculated as IVRT/[ln{SBP]-ln(EDP)] were measured. Ability of parameters to predict EDP was compared using linear regression. Receiver operating characteristic analysis was used to evaluate parameters’ ability to discriminate EDP of ≥20 mmHg. Only E/e’ ratio significantly correlated with EDP (r= 0.56, p<0.001), with the correlation being significantly stronger than the correlation between other parameters and EDP (Table). Lateral e’ and averaged e’ were significantly associated with tau (r=-0.44, p=0.003 and -0.38, p=0.012) but septal e’ was not (p=0.20). By ROC analysis, averaged E/e’ had the best discriminative power to detect elevated EDP (AUC 0.78, p= 0.005), with sensitivity 82% and specificity 66% at the cut-off of 10.1.

Conclusion: E/e’ ratio predicts elevated EDP, while lateral and averaged mitral annulus velocities correlate with tau in transplant patients.