Key result
Mitral E/SR(IVR) strongly correlates with mean wedge pressure, accurately predicting LV filling pressures.
Why the study?
Diastolic strain rate measurements comprising all LV segments may better assess diastolic function and estimate LV filling pressures than myocardial velocity, but their clinical utility requires evaluation.
Does global diastolic strain rate by 2D speckle tracking accurately estimate left ventricular relaxation and filling pressures compared to invasive hemodynamics?
Observational (n=74)
Does global diastolic strain rate by 2D speckle tracking accurately estimate left ventricular relaxation and filling pressures compared to invasive hemodynamics?
Global diastolic strain rate during isovolumetric relaxation (E/SR(IVR)) provides a highly accurate, non-invasive estimation of LV filling pressures, outperforming E/Ea in patients with normal ejection fraction and regional dysfunction.
Answers are grounded in this paper and cite their sources.
E/SR(IVR) may aid non-invasive wedge pressure estimation over E/Ea in select patients; leaves open prospective validation before practice change.
BACKGROUND: Diastolic strain rate (SR) measurements that comprise all left ventricular (LV) segments are advantageous over myocardial velocity for assessment of diastolic function. Mitral early diastolic velocity (E)/SR ratio during the isovolumetric relaxation (IVR) period can be used to estimate LV filling pressures. METHODS AND RESULTS: Simultaneous echocardiographic imaging and LV pressure measurements (7F catheters) were performed in 7 adult dogs. Loading conditions were altered by saline infusion and caval occlusion, and lusitropic state was changed by dobutamine and esmolol infusion. A curve depicting global SR was derived from each of the 3 apical views, and SR was measured during IVR (SR(IVR)) and early LV filling (SR(E)). SR(IVR) had a strong correlation with time constant of LV pressure decay during the IVR period (tau) (r=-0.83, P<0.001), whereas SR(E) was significantly related to LV end-diastolic pressure (r=0.52, P=0.005) in the experimental stages where tau was <40 ms. In 50 patients with simultaneous right heart catheterization and echocardiographic imaging, mitral E/SR(IVR) ratio had the best correlation with mean wedge pressure (r=0.79, P<0.001), as well as in 24 prospective patients (r=0.84, P=0.001). E/SR(IVR) was most useful in patients with ratio of E to mitral annulus early diastolic velocity (E/Ea ratio) 8 to 15 and was more accurate than E/Ea in patients with normal ejection fraction and regional dysfunction (both P<0.01). CONCLUSIONS: Global SR(IVR) by 2-dimensional speckle tracking is strongly dependent on LV relaxation. E/SR(IVR) can predict LV filling pressures with reasonable accuracy, particularly in patients with normal ejection fraction and in those with regional dysfunction.
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Wang et al. (2007) conducted an observational in Left ventricular filling pressure assessment (n=74). Mitral E/SR(IVR) ratio (Global Diastolic Strain Rate) vs. E/Ea ratio was evaluated on Correlation with mean wedge pressure (r=0.79, p=<0.001). The mitral E/SR(IVR) ratio strongly correlated with mean wedge pressure (r=0.79, P<0.001), accurately predicting left ventricular filling pressures.
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