Prediction of Left Ventricular Filling Pressure by 3-Dimensional Speckle-Tracking Echocardiography in Patients With Coronary Artery Disease.
OBJECTIVE
The purpose of this study was to investigate the diagnostic value of 3-dimensional (3D) speckle-tracking echocardiography for estimating left ventricular filling pressure in patients with coronary artery disease (CAD) and a preserved left ventricular ejection fraction.


METHODS
Altogether, 84 patients with CAD and 30 age- and sex-matched healthy control participants in sinus rhythm were recruited prospectively. All participants underwent conventional and 3D speckle-tracking echocardiography. Global strain values were automatically calculated by 3D speckle-tracking analysis. The left ventricular end-diastolic pressure (LVEDP) was determined invasively by left heart catheterization. Echocardiography and cardiac catheterization were performed within 24 hours.


RESULTS
Compared with the controls, patients with CAD showed lower global longitudinal strain, global circumferential strain, global area strain, and global radial strain. Patients with CAD who had an elevated LVEDP had much lower levels of all 4 3D-speckle-tracking echocardiographic variables. Pearson correlation analysis revealed that the LVEDP correlated positively with the early transmitral flow velocity/early diastolic myocardial velocity (E/E') ratio, global longitudinal strain, global circumferential strain, and global area strain. It correlated negatively with global radial strain. Receiver operating characteristic curve analysis revealed that these 3D speckle-tracking echocardiographic indices could effectively predict elevated left ventricular filling pressure (LVEDP >15 mm Hg) in patients with CAD (areas under the curve: global longitudinal strain, 0.78; global radial strain, 0.77; global circumferential strain, 0.75; and global area strain, 0.74). These parameters, however, showed no advantages over the commonly used E/E' ratio (area under the curve, 0.84).


CONCLUSIONS
Three-dimensional speckle-tracking echocardiography was a practical technique for predicting elevated left ventricular filling pressure, but it might not be superior to the commonly used E/E' ratio in patients with CAD who have a normal left ventricular ejection fraction.
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.).
Hong
H
Ma
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.).
Rong-Ai
RA
Xie
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.).
Li-Jian
LJ
Gao
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.).
Jin-Ping
JP
Zhang
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.). achundoctor@163.com fwyywangh@163.com.
Wei-Chun
WC
Wu
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.). achundoctor@163.com fwyywangh@163.com.
Hao
H
Wang
D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology; D017725:Ventricular Pressure
3-dimensional speckle-tracking echocardiography; coronary artery disease; left ventricular filling pressure; vascular ultrasound