Key result
Echo-derived LV stiffness indices correlate only moderately with invasive methods and require further validation.
Why the study?
Increased LV stiffness plays a key role in HFpEF, but clinical application has been limited by the need for invasive catheterization, prompting the need to summarize advances in noninvasive echocardiographic assessment.
Do echocardiography-derived indices accurately assess left ventricular stiffness compared to invasive catheterization in patients with heart failure?
Do echocardiography-derived indices accurately assess left ventricular stiffness compared to invasive catheterization in patients with heart failure?
While echocardiography offers noninvasive estimation of LV stiffness, current indices have significant limitations and moderate accuracy, highlighting the need for better validated parameters.
Answers are grounded in this paper and cite their sources.
Current echocardiographic LV stiffness indices warrant caution in HF due to moderate invasive correlations; leaves open need for validated noninvasive parameters.
Half of patients with heart failure are presented with preserved ejection fraction (HFpEF). The pathophysiology of these patients is complex but increased left ventricular (LV) stiffness is proved to play a key role. However, the application of this parameter was limited since its measurements requires invasive catheterization. With advances in ultrasound technology, new advances have been achieved in the assessment of LV chamber or myocardial stiffness using noninvasive echocardiography. Therefore, this review was carried out to summarize the pathophysiological mechanisms, correlations with invasive LV stiffness constant, applications in different populations as well as the limitations of echocardiography-derived indices for assessment of both LV chamber and myocardial stiffness. LV chamber stiffness indices such as E/e’/LVEDV, E/SRe/LVEDV, and DPVQ were derived on the basis of the relationship between echocardiographic parameters of LVFP and LV size. However, all these methods are surrogate and lumped measurements, relying on E/e’ or E/SRe for evaluating LVFP. The limitations of E/e’ or E/SRe in assessment of LVFP may contribute to the moderate correlation between E/e’/LVEDV or E/SRe/LVEDV and LV stiffness constant. Even the best validated measurement (DPVQ) is considered unreliable in the individual patient. Compared to E/e’/LVEDV and E/SRe/LVEDV, I PVA/IA and F PVA/FA may display better performance in assessing LV chamber stiffness as evidenced by a higher correlation with LV stiffness constant. However, only one study has been conducted in the literature on the exploration and application of I PVA /I A and F PVA /F A , and its accuracy in assessing LV chamber stiffness remains to be confirmed. In terms of echocardiographic indices for LV myocardial stiffness evaluation, the parameters of EMI/DWS, iVP and SWI were proposed. Despite alteration of DWS and its predictive value of adverse outcomes in various populations have been widely validated, it was found that DWS may be better considered as an overall marker of cardiac function performance instead of pure myocardial stiffness. As for the iVP and SWI, the validities of these two indices in assessing LV myocardial stiffness have not been confirmed in invasive studies. More echocardiographic indices with higher sensitivities and specificities warrant to be further uncovered to evaluate LV stiffness.
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Wang et al. (2023) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Echocardiography-derived indices for LV stiffness vs. Invasive catheterization was evaluated. Noninvasive echocardiography-derived indices for left ventricular stiffness currently rely on surrogate measurements with moderate correlation to invasive methods, requiring further validation.
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