Comparison between Invasive and Echocardiographic Assessment of Left Ventricular Function in Healthy participants

Objectives Accurate assessment of LV function is of great importance but still challenging. Despite the invasive measure is the gold standard, non-invasive ultrasound is widely used due to its convenience. We aimed to compare the accuracy of several methods assessing LV function in echocardiography. Methods 49 healthy participants who underwent transthoracic echocardiography and catheterization simultaneously were included. Invasive LVEF and LVFP were measured with Sandler-Dodge method. Non-invasive LV systolic function was measured with both the M-mode method and the modified Simpson method. Parameters related to LV diastolic function in echocardiography including E/A, E/e′, tricuspid regurgitation velocity, left atrial volume index, etc., were measured. Results Correlations between invasive and non-invasive LVESV, LVEDV, and LVEF were not significant ((P=0.07 and P=0.97, P=0.17 and P=0.74, P=0.64 and P=0.52). Compared to invasive measurements, the modified Simpson method overestimated the LV end-systolic volume (P=0.001), and M-mode method overestimated the LV end-diastolic volume (P=0.047). Both of these two methods underestimated the LVEF (P=0.027 and P<0.001). Invasive left ventricular end-diastolic pressure (LVEDP) was elevated in 23 of the 49 patients (47%). Compared to participants with normal LVEDP, participants with elevated LVEDP (>16mmHg) had higher A peak velocity (P=0.009) and lower E/A ratio (P=0.001). Multiple linear regression showed that, among all parameters related to LV diastolic function, only E/A significantly associated with LVEDP after adjustment (P=0.006). We further compared the sensitivity and specificity of E/A ,E/e’ and the method recommended by 2016 ASE/EACVI guideline in identifying LV diastolic dysfunction. E/A was with both higher sensitivity and higher specificity in the detection of LVEDP elevation. Conclusions Both the Simpson method and the M-mode method underestimate the LVEF. In terms of LV diastolic function assessment, E/A ratio is better associated with invasively-measured LVEDP compared to other conventional parameters.