Serial Doppler Echocardiography and Tissue Doppler Imaging in the Detection of Elevated Directly Measured Left Atrial Pressure in Ambulant Subjects With Chronic Heart Failure
Author + information
- Jay L. Ritzema, MD, PhD⁎,#,⁎ (jayritzema{at}gmail.com),
- A. Mark Richards, MD, DSc⁎,
- Ian G. Crozier, MD†,
- Christopher F. Frampton, PhD⁎,
- Iain C. Melton, MD†,
- Robert N. Doughty, MD‡,
- James T. Stewart, MD‡,
- Neal Eigler, MD§∥,
- James Whiting, PhD§∥,
- William T. Abraham, MD¶ and
- Richard W. Troughton, MD, PhD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Jay Ritzema, Department of Cardiology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4012, Australia
Abstract
Objectives This study sought to determine the accuracy of Doppler echocardiography and tissue Doppler imaging (TDI) measurements in detecting elevated left atrial pressure (LAP) in ambulant subjects with chronic heart failure using directly measured LAP as the reference.
Background Echocardiographic indexes including the ratio of transmitral to annular early diastolic velocities (E/e′) may identify raised invasively measured left ventricular filling pressures when tested in cross-sectional studies in some populations. The accuracy of these indexes when measured sequentially remains untested. We determined the accuracy of Doppler echocardiography and TDI measurements in detecting elevated directly measured LAP in ambulant subjects with stable chronic heart failure.
Methods Fifteen patients with New York Heart Association functional class II to III heart failure and a permanently implanted direct LAP monitoring device underwent serial echocardiography. Simultaneous resting mean LAP, Doppler mitral inflow, mitral annular TDI, and pulmonary venous inflow velocities were obtained on each occasion. Receiver-operator characteristic curve analysis was used to compare the accuracy of the Doppler variables to detect an elevated device LAP ≥15 and ≥20 mm Hg.
Results The patients (13 men, mean age: 71 years, mean left ventricular ejection fraction: 32 ± 12%) underwent 60 simultaneous echocardiographic studies and LAP measurements with a median of 4 (1 to 7) studies per patient. Mean LAP was 16.9 (range 5 to 39 mm Hg) at echocardiography (n = 60). E/e′ had the greatest accuracy for detection of LAP ≥15 mm Hg with an area beneath the receiver-operator characteristic curve >0.9. In comparison, area under the curve for mitral E velocity and mitral E/A were 0.77 and 0.76, respectively (p < 0.008 vs. E/e′ medial and average).
Conclusions Single and serial measurements of mitral inflow and mitral annular TDI velocities (E/e′) can reliably detect raised directly measured LAP in ambulant subjects with compensated chronic heart failure. (Hemodynamically Guided Home Self-Therapy in Severe Heart Failure Patients [HOMEOSTASIS]; NCT00547729)
Footnotes
The HOMEOSTASIS trial (HeartPOD LAP monitoring device) was sponsored by St. Jude Medical Inc. Dr. Ritzema was supported by a grant from the National Heart Foundation of New Zealand. Drs. Eigler and Whiting have a financial interest in the manufacturer of the study device. Drs. Abraham and Troughton have received honoraria or consulting fees from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 19, 2010.
- Revision received July 12, 2011.
- Accepted July 13, 2011.
- American College of Cardiology Foundation
