title: Diastolic pressure-volume quotient (DPVQ) as a novel echocardiographic index for estimation of LV stiffness in HFpEF.
abstract: BACKGROUND
  End-diastolic pressure-volume relationship and LV stiffness, key parameter for diagnosing diastolic dysfunction within Heart failure with preserved ejection fraction (HFpEF) patients, can be directly obtained only by invasive pressure-volume (PV) measurements. Therefore, we aimed to establish diastolic pressure-volume quotient (DPVQ), as a new non-invasive parameter for estimation of LV stiffness in HFpEF obtained by 3D echocardiography (3DE) and tissue Doppler imaging.
  
  
  METHODS
  Twenty-three HFpEF patients with suspected diastolic dysfunction, scheduled for invasive pressure-volume loop analyses obtained by conductance catheterization were included. PV loop measurements were compared with simultaneous 3DE full-volume recordings of the LV and tissue Doppler measurements for LV diastolic function. LV filling index E/E' was used for estimation of diastolic pressure. Single-beat method was performed to calculate LV stiffness constant (β SB).
  
  
  RESULTS
  Fourteen of twenty-three patients showed increased and 9/23 revealed normal LV stiffness β. End-diastolic, end-systolic and stroke volume obtained by 3DE correlated with those from PV loop analysis (r = 0.63, r = 0.57 and r = 0.71, respectively). Estimated diastolic pressure and DPVQ correlated with invasive measurements (r = 0.81 and r = 0.91, both p < 0.001). Accordingly, calculated stiffness constant β SB revealed a significant correlation with invasive determined stiffness coefficient β (r = 0.73, p < 0.001). DPVQ and β SB correlated with NT-proBNP plasma level (r = 0.67 and r = 0.58, both, p < 0.001).
  
  
  CONCLUSIONS
  3D echocardiography allows accurate non-invasive measurements of diastolic pressure-volume quotient which correlates with invasive determined LV stiffness in HFpEF.
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. mario_kasner@yahoo.com.
authors.forename: Mario
authors.initials: M
authors.lastname: Kasner
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Sinning
authors.affiliation: Division of Cardiology, Columbia University, New York, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Burkhoff
authors.affiliation: Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.|Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.|German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Tschöpe
mesh_terms: D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: Diastolic dysfunction; Echocardiography (three-dimensional); Heart failure; Pressure–volume relationship; Tissue Doppler