Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction
Language English Country United States Media print-electronic
Document type Journal Article
PubMed
27779336
DOI
10.1111/echo.13403
Knihovny.cz E-resources
- Keywords
- biomarkers, exercise left atrial pressure, exercise mitral E/e′ ratio,
- MeSH
- Exercise physiology MeSH
- Diastole MeSH
- Echocardiography methods MeSH
- Atrial Fibrillation diagnosis physiopathology MeSH
- Ventricular Function, Left physiology MeSH
- Ventricular Pressure physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Mitral Valve diagnostic imaging physiopathology MeSH
- Predictive Value of Tests MeSH
- Reproducibility of Results MeSH
- Blood Flow Velocity MeSH
- Systole MeSH
- Stroke Volume physiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article 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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