Publication details

Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction


MELUZÍN Jaroslav STÁREK Zdeněk KULÍK Tomáš JEŽ Jiří LEHAR František TOMANDL Josef DUŠEK Ladislav WOLF Jiří LEINVEBER Pavel NOVÁK Miroslav

Year of publication 2017
Type Article in Periodical
Magazine / Source Echocardiography
MU Faculty or unit

Faculty of Medicine

Field Cardiovascular diseases incl. cardiosurgery
Keywords biomarkers; exercise left atrial pressure; exercise mitral E/e ratio
Description Background: Noninvasive diagnosis of exercise-induced elevation of left ventricular filling pressure is difficult and remains unsatisfactory. The aim of this study was to assess the accuracy of the ratio of early diastolic transmitral (E) to mitral annular (e) velocity and to determine new parameters or parameter combinations with the ability to predict exercise-induced left atrial pressure (LAP) elevation. Methods and results: Eighty patients with paroxysmal atrial fibrillation (AF) referred for catheter AF ablation underwent simultaneous exercise echocardiography and direct invasive LAP measurements, as well as a resting and postexercise biomarker analysis. Exercise E/e >=8.85 predicted exercise LAP >=20 mm Hg with 61.5% sensitivity and 88.9% specificity (area under the curve [AUC], 0.76). Of all of the individual parameters tested, the best prediction was achieved with exercise E/s (s=peak systolic mitral annular velocity) >=8.75 (sensitivity, 88.5%; specificity, 64.8%; positive predictive value, 54.8%; negative predictive value, 92.1%; AUC, 0.84). However, the combination of exercise E/A (A = late diastolic transmitral flow velocity) >=1.22 + exercise E/e >=8.85 + exercise s<=11.05 cm/s provided the most precise prediction of exercise LAP elevation (sensitivity, 84.6%; specificity, 79.6%; positive predictive value, 66.7%; negative predictive value, 91.5%; AUC, 0.90). Conclusions: Exercise E/e, when used as a sole parameter, was not sufficiently reliable to predict exercise-induced elevation of LAP. The application of a multivariate-adjusted combination of parameters appeared to be the preferable approach for the noninvasive prediction of exercise LAP elevation.

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