Improvement in the prediction of exercise-induced elevation of
left ventricular filling pressure in patients with normal left
ventricular ejection fraction

J 2017

Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction

MELUZÍN, Jaroslav; Zdeněk STÁREK; Tomáš KULÍK; Jiří JEŽ; František LEHAR et al.

Basic information

Original name

Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction

Authors

MELUZÍN, Jaroslav; Zdeněk STÁREK; Tomáš KULÍK; Jiří JEŽ; František LEHAR; Josef TOMANDL ; Ladislav DUŠEK; Jiří WOLF; Pavel LEINVEBER and Miroslav NOVÁK

Edition

Echocardiography, Hoboken, Wiley-Blackwell, 2017, 0742-2822

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

is not subject to a state or trade secret

Impact factor

Impact factor: 1.197

Marked to be transferred to RIV

Yes

RIV identification code

RIV/00216224:14110/17:00096178

Organization unit

Faculty of Medicine

Keywords in English

biomarkers; exercise left atrial pressure; exercise mitral E/e ratio

Abstract

In the original language

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. Methods and 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.

Cite

MELUZÍN, Jaroslav; Zdeněk STÁREK; Tomáš KULÍK; Jiří JEŽ; František LEHAR; Josef TOMANDL; Ladislav DUŠEK; Jiří WOLF; Pavel LEINVEBER and Miroslav NOVÁK. Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction. Echocardiography. Hoboken: Wiley-Blackwell, 2017, vol. 34, No 1, p. 78-86. ISSN 0742-2822. Available from: https://doi.org/10.1111/echo.13403.

@article{1373113,
   author = {Meluzín, Jaroslav and Stárek, Zdeněk and Kulík, Tomáš and Jež, Jiří and Lehar, František and Tomandl, Josef and Dušek, Ladislav and Wolf, Jiří and Leinveber, Pavel and Novák, Miroslav},
   article_location = {Hoboken},
   article_number = {1},
   doi = {https://doi.org/10.1111/echo.13403},
   keywords = {biomarkers; exercise left atrial pressure; exercise mitral E/e ratio},
   language = {eng},
   issn = {0742-2822},
   journal = {Echocardiography},
   title = {Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction},
   volume = {34},
   year = {2017}
}

TY  - JOUR
ID  - 1373113
AU  - Meluzín, Jaroslav - Stárek, Zdeněk - Kulík, Tomáš - Jež, Jiří - Lehar, František - Tomandl, Josef - Dušek, Ladislav - Wolf, Jiří - Leinveber, Pavel - Novák, Miroslav
PY  - 2017
TI  - Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction
JF  - Echocardiography
VL  - 34
IS  - 1
SP  - 78-86
EP  - 78-86
PB  - Wiley-Blackwell
SN  - 07422822
KW  - biomarkers
KW  - exercise left atrial pressure
KW  - exercise mitral E/e ratio
N2  - 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. Methods and 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.
ER  -

MELUZÍN, Jaroslav; Zdeněk STÁREK; Tomáš KULÍK; Jiří JEŽ; František LEHAR; Josef TOMANDL; Ladislav DUŠEK; Jiří WOLF; Pavel LEINVEBER and Miroslav NOVÁK. Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction. \textit{Echocardiography}. Hoboken: Wiley-Blackwell, 2017, vol.~34, No~1, p.~78-86. ISSN~0742-2822. Available from: https://doi.org/10.1111/echo.13403.

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