Noninvasive prediction of the exercise-induced elevation in left ventricular filling pressure in post-heart transplant patients with normal left ventricular ejection fraction.
OBJECTIVE
At present, there are conflicting data on the ability of echocardiographic parameters to predict the exercise-induced elevation of left ventricular (LV) filling pressure. The purpose of the present study was to validate the ratio of early diastolic transmitral (E) to mitral annular velocity (e') obtained at peak exercise in its capacity to determine the exercise-induced elevation of pulmonary capillary wedge pressure (PCWP) and to reveal new noninvasive parameters with such capacity.


METHODS
Sixty-one patients who had undergone heart transplantation with normal LV ejection fraction underwent simultaneous exercise echocardiography and right heart catheterization.


RESULTS
In 50 patients with a normal PCWP at rest, exercise E/e' ≥8.5 predicted exercise PCWP ≥25 mmHg with a sensitivity of 64.3% and a specificity of 84.2% (area under the curve [AUC]=0.74). A comparable or slightly better prediction was achieved by exercise E/peak systolic mitral annular velocity (s') ≥11.0 (sensitivity 79.3%; specificity 57.9%; AUC=0.75) and exercise E/LV systolic longitudinal strain rate ≤-105 cm (sensitivity 78.9%; specificity 78.6%; AUC=0.87). Combined, exercise E/s' and exercise E/e' resulted in a trend toward a slightly more precise prediction (sensitivity 53.6%; specificity 89.5%; AUC=0.78) than did either variable alone.


CONCLUSIONS
Exercise E/e', used as a sole parameter, is not sufficiently precise to predict the exercise-induced elevation of PCWP. Exercise E/s', E/LV systolic longitudinal strain rate or combinations of these parameters may represent further promising possibilities for predicting exercise PCWP elevation.
Department of Cardiovascular Diseases, International Clinical Research Center, St Anne's Hospital, Brno, Czech Republic ; Department of Cardiovascular Diseases, St Anne's Hospital, Brno, Czech Republic.
Jaroslav
J
Meluzin
Petr
P
Hude
Jan
J
Krejci
Lenka
L
Spinarova
Helena
H
Podrouzkova
Pavel
P
Leinveber
Ladislav
L
Dusek
Vladimir
V
Soska
Josef
J
Tomandl
Petr
P
Nemec
Diastolic function; Exercise echocardiography; Pulmonary capillary wedge pressure