Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články
PubMed
27779336
DOI
10.1111/echo.13403
Knihovny.cz E-zdroje
- Klíčová slova
- biomarkers, exercise left atrial pressure, exercise mitral E/e′ ratio,
- MeSH
- cvičení fyziologie MeSH
- diastola MeSH
- echokardiografie metody MeSH
- fibrilace síní diagnóza patofyziologie MeSH
- funkce levé komory srdeční fyziologie MeSH
- komorový tlak (srdce) fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mitrální chlopeň diagnostické zobrazování patofyziologie MeSH
- prediktivní hodnota testů MeSH
- reprodukovatelnost výsledků MeSH
- rychlost toku krve MeSH
- systola MeSH
- tepový objem fyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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.
Department of Biochemistry Faculty of Medicine Masaryk University Brno Czech Republic
Department of Biochemistry ICRC Brno Czech Republic
Department of Cardiovascular Diseases Faculty of Medicine Masaryk University Brno Czech Republic
Department of Cardiovascular Diseases ICRC St Anne's University Hospital Brno Czech Republic
Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic
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