Key result
E/e' ratio outperforms speckle tracking E/GCSR_E for detecting elevated LVEDP in CAD with preserved LVEF.
Why the study?
Traditional echocardiographic tools correlate weakly with LV filling pressures in CAD patients with preserved LVEF, and speckle tracking echocardiography had not been exclusively evaluated against invasive measurements in this population.
Does the E/e' ratio improve the detection of elevated left ventricular end-diastolic pressure compared to speckle tracking in patients with coronary artery disease and preserved ejection fraction?
Does the E/e' ratio improve the detection of elevated left ventricular end-diastolic pressure compared to speckle tracking in patients with coronary artery disease and preserved ejection fraction?
The traditional E/e' ratio is more accurate than speckle tracking echocardiography for identifying elevated LVEDP in patients with CAD and preserved LVEF.
Answers are grounded in this paper and cite their sources.
E/e' may outperform speckle tracking for elevated LVEDP detection in CAD with preserved LVEF; hypothesis-generating and requires prospective validation.
Background A weak correlation has been reported between left ventricular filling pressures and the traditional echocardiographic tools for the evaluation of diastolic function in patients with coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF). On the other hand, studies that compared invasive measurements with speckle tracking echocardiography have shown promising results, but they were not exclusively targeted on this specific population. Methods and Results Immediately before the left heart catheterization, a comprehensive two‐dimensional Doppler echocardiography and speckle tracking analysis was prospectively performed in outpatients referred for coronary angiography. Left ventricular end‐diastolic pressure (LVEDP) was measured before any contrast exposure. Eighty‐one patients with coronary artery disease were studied, and the group with high LVEDP (n = 40) showed increased left atrial volume index (22 ± 6 mL/m 2 vs 26 ± 8.26 mL/m 2 , P = 0.04), E‐wave velocity (65 ± 15 cm/s vs 78 ± 20 cm/s, P = 0.02), E/e` (average) ratio (8.14 ± 2.0 vs 11.54 ± 2.7, P = 0.03), and E/global circumferential strain rate E peak ratio (E/GCSR E ) (39 cm vs 46 cm, P < 0.01). There was a positive correlation between LVEDP and E/e` (ρ = 0.56; P = 0.03), and between LVEDP and E/GCSR E ratio (ρ = 0.43; P < 0.01). The area under the receiver operating characteristics (ROC) curve was 0.83 and 0.73, respectively ( P < 0.05). E/e` and E/GCSR E were both independent predictors of elevated LVEDP ( P < 0.05), with a higher C‐statistic for the model including E/e` (0.89 vs 0.85). Conclusion The E/e` ratio was able to identify elevated LVEDP in CAD patients with preserved LVEF with more accuracy than the E/GCSR E ratio.
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Júnior et al. (2019) studied this question. The E/e' ratio was superior to the speckle tracking E/GCSR_E ratio for detecting elevated LVEDP in patients with CAD and preserved LVEF.
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