Abstract 17620: Does Doppler E/e’ Ratio Reliably Estimate Diastolic Filling Pressures in Stress Cardiomyopathy?: A Validation Study in Apical and non-Apical Phenotypes
BACKGROUND: We have recently shown that mean LV end diastolic pressure (LVEDP) is commonly elevated in apical ("Tako-tsubo") stress cardiomyopathy (SCM) and likely contributes to heart failure in this syndrome. The assessment of diastolic filling pressures by use of E/e’ ratio (early diastolic transmitral E to tissue Doppler e') has been applied to many forms of heart disease, but has not been validated in SCM, and has not been studied in the apical sparing variant.
METHODS: We identified 62 patients with SCM, 43 patients with apical/Tako-tsubo SCM and 19 patients with apical sparing (basal and midventricular) variant of SCM, who underwent measurement of E/e', using the average of lateral and septal e’ (cm/s), within 48 hours of direct invasive measurement of LVEDP (mm Hg).
RESULTS: LVEDP was significantly higher in apical sparing SCM compared to apical SCM (28 ± 6 mmHg vs. 22 ± 7 mmHg, p<0.002). LVEDP directly correlated with E/e’ ratio in apical SCM (r = 0.64, p < 0.0001, Figure 1). When individual data were examined, we found that of the apical SCM group, 3 pts had normal LVEDP and were correctly identified with normal E/e’ ratio (< 8). All apical SCM patients with elevated LVEDP (16 mm Hg or greater) had E/e’ > 8, and fifteen of these had E/e’ ratio > 15.
By contrast, all apical sparing SCM had elevated LVEDP. In this group, E/e’ did not predict LVEDP: the overall correlation between E/e’ and LVEDP (r = 0.27, p = 0.26, Figure 2) was poor. When individual data were examined, 5 patients with elevated LVEDP had normal E/e’ and, of the remaining 14 patients with elevated LVEDP, only 1 patient had E/e’ >15.
CONCLUSION: Our results demonstrate:
1. Elevated LVEDP is found among 95% of SCM, regardless of the phenotype.
2. Unexpectedly, apical sparing SCM appears to have worse impairment of diastolic function and higher LVEDP than apical variant SCM
3. E/e’ ratio reliably predicts LVEDP in pts with apical variant SCM; by contrast, this index underestimates LVEDP among patients with apical sparing SCM.
Author Disclosures: A. Iskandar: None. G.P. Aurigemma: None. T.P. Fitzgibbons: None. M. Ahmed: None. D. Tighe: None.
- © 2014 by American Heart Association, Inc.