Key result
The novel echocardiographic parameter E/DT demonstrated excellent diagnostic accuracy for detecting lung remodeling (AUC 0.98), significantly outperforming the tissue Doppler index E/e' (AUC 0.82).
Why the study?
Does the E-wave deceleration rate (E/DT) outperform E/e' in predicting lung remodeling in a rat model of HFpEF?
Does the E-wave deceleration rate (E/DT) outperform E/e' in predicting lung remodeling in a rat model of HFpEF?
In a rat model of HFpEF, the novel echocardiographic parameter E/DT outperformed the widely used E/e' index in detecting and monitoring pressure overload-induced lung remodeling.
BACKGROUND: Diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF) may result in pulmonary congestion and lung remodeling. We evaluated the usefulness of major diastolic echocardiographic parameters and of the deceleration rate of early transmitral diastolic velocity (E/DT) in predicting lung remodeling in a rat model of HFpEF. METHODS AND RESULTS: Rats underwent aortic banding (AoB) to induce pressure overload (PO). Left ventricular hypertrophy fully developed 2 weeks after AoB. At 4 and 6 weeks, the lung weight-to-body weight ratio (LW/BW), a sensitive marker for pulmonary congestion and remodeling, dramatically increased despite preserved fractional shortening, indicating the presence of HFpEF. The time course of LW/BW was well reflected by E/DT, by the ratio of early to late transmitral diastolic velocity (E/A) and the deceleration time of E (DT), but not by the ratio of transmitral to mitral annular early diastolic velocity (E/e'). In agreement, the best correlation with LW/BW was found for E/DT (r = 0.76; p<0.0001), followed by E/A (r = 0.69; p<0.0001), DT (r = -0.62; p<0.0001) and finally E/e' (r = 0.51; p<0.001). Furthermore, analysis of receiver-operating characteristic curves for the prediction of increased LW/BW revealed excellent area under the curve values for E/DT (AUC = 0.98) and DT (AUC = 0.95), which are significantly higher than that of E/e' (AUC = 0.82). In a second approach, we also found that the new parameter E/DT correlated well with right ventricular weight index and echocardiographic measures of right ventricular systolic function. CONCLUSIONS: The novel parameter E/DT outperforms the tissue Doppler index E/e' in detecting and monitoring lung remodeling induced by pressure overload. The results may provide a handy tool to point towards secondary lung disease in HFpEF and warrant further clinical investigations.
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Nguyễn et al. (2013) studied Heart failure with preserved ejection fraction (HFpEF) and lung remodeling. E-Wave Deceleration Rate (E/DT) vs. Tissue Doppler-Derived Index (E/e') was evaluated on Prediction of increased lung weight-to-body weight ratio (LW/BW) as a marker of lung remodeling (AUC 0.98, p=<0.0001). The novel echocardiographic parameter E/DT demonstrated excellent diagnostic accuracy for detecting lung remodeling (AUC 0.98), significantly outperforming the tissue Doppler index E/e' (AUC 0.82).
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