title: Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction.
abstract: BACKGROUND
  Noninvasive diagnosis of exercise-induced elevation of left ventricular filling pressure is difficult and remains unsatisfactory. The aim of this study was to assess the accuracy of the ratio of early diastolic transmitral (E) to mitral annular (e') velocity and to determine new parameters or parameter combinations with the ability to predict exercise-induced left atrial pressure (LAP) elevation.
  
  
  RESULTS
  Eighty patients with paroxysmal atrial fibrillation (AF) referred for catheter AF ablation underwent simultaneous exercise echocardiography and direct invasive LAP measurements, as well as a resting and postexercise biomarker analysis. Exercise E/e' ≥8.85 predicted exercise LAP ≥20 mm Hg with 61.5% sensitivity and 88.9% specificity (area under the curve [AUC], 0.76). Of all of the individual parameters tested, the best prediction was achieved with exercise E/s' (s'=peak systolic mitral annular velocity) ≥8.75 (sensitivity, 88.5%; specificity, 64.8%; positive predictive value, 54.8%; negative predictive value, 92.1%; AUC, 0.84). However, the combination of exercise E/A (A = late diastolic transmitral flow velocity) ≥1.22 + exercise E/e' ≥8.85 + exercise s'≤11.05 cm/s provided the most precise prediction of exercise LAP elevation (sensitivity, 84.6%; specificity, 79.6%; positive predictive value, 66.7%; negative predictive value, 91.5%; AUC, 0.90).
  
  
  CONCLUSIONS
  Exercise E/e', when used as a sole parameter, was not sufficiently reliable to predict exercise-induced elevation of LAP. The application of a multivariate-adjusted combination of parameters appeared to be the preferable approach for the noninvasive prediction of exercise LAP elevation.
authors: Department of Cardiovascular Diseases, ICRC, St. Anne's University Hospital, Brno, Czech Republic.|Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Jaroslav
authors: J
authors: Meluzin
authors: Department of Cardiovascular Diseases, ICRC, St. Anne's University Hospital, Brno, Czech Republic.|Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Zdenek
authors: Z
authors: Starek
authors: Department of Cardiovascular Diseases, ICRC, St. Anne's University Hospital, Brno, Czech Republic.|Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Tomas
authors: T
authors: Kulik
authors: Department of Cardiovascular Diseases, ICRC, St. Anne's University Hospital, Brno, Czech Republic.|Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Jiri
authors: J
authors: Jez
authors: Department of Cardiovascular Diseases, ICRC, St. Anne's University Hospital, Brno, Czech Republic.|Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Frantisek
authors: F
authors: Lehar
authors: Department of Biochemistry, ICRC, Brno, Czech Republic.|Department of Biochemistry, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Josef
authors: J
authors: Tomandl
authors: Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Ladislav
authors: L
authors: Dusek
authors: Department of Cardiovascular Diseases, ICRC, St. Anne's University Hospital, Brno, Czech Republic.|Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Jiri
authors: J
authors: Wolf
authors: Department of Cardiovascular Diseases, ICRC, St. Anne's University Hospital, Brno, Czech Republic.
authors: Pavel
authors: P
authors: Leinveber
authors: Department of Cardiovascular Diseases, ICRC, St. Anne's University Hospital, Brno, Czech Republic.|Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Miroslav
authors: M
authors: Novak
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology; D001783:Blood Flow Velocity; D003971:Diastole; D004452:Echocardiography / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*
keywords: biomarkers; exercise left atrial pressure; exercise mitral E/e′ ratio