P655Head-to-head comparison of left atrial strain and E/e ratio in the prediction of high wedge pressure in chronic coronary heart disease


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Abstract

Purpose: To compare the capability of Speckle Tracking derived left atrial strain (LA [Latin Small Letter Open E]) and E/e' ratio in predicting pulmonary capillary wedge pressure (PCWP) in chronic coronary heart disease (CHD).Methods: 36 patients with CHD undergoing coronary angiography were studied by almost simultaneous assessment of PCWP, LA [Latin Small Letter Open E] and E/e' (lateral mitral annulus). Global LA [Latin Small Letter Open E] was determined by 2 different modalities: the first measured positive peak LA longitudinal [Latin Small Letter Open E] (average of 12 ROIs in apical 4- and 2-chamber views) taking QRS onset as reference point (LA QRS-[Latin Small Letter Open E]); the second one measured sum of first negative peak LA strain and second peak LA strain using P wave as reference point (mean of 15 ROIs from apical 4-, 2- and 3-chamber [only 3 ROIs of LA infero-posterior wall) views (LA P-[Latin Small Letter Open E]). Patients were divided in 2 groups according to PCWP: 22 with PCWP <18 and 14 with PCWP ≥18 mmHg.Results: The 2 groups were comparable for age, pressure, heart rate and ejection fraction. Patients with PCWP ≥ 18 mmHg showed higher E/e' (13 ± 5 vs 8 ± 3, p<0.001) and both lower LA QRS-[Latin Small Letter Open E] (21 ± 5 % vs. 28 ± 7%, p<0.005) and LA P-[Latin Small Letter Open E] (22 ± 6% vs. 29 ± 7%, p<0.002). In the overall population PWCP was related positively with E/e' (r = 0.61, p<0.0001) and negatively with both LA QRS-[Latin Small Letter Open E] (r = -0.46, p<0.005) and LA P-[Latin Small Letter Open E] (r = -0.50, p<0.002). By ROC curves, E/e' showed higher accuracy (cut-off point ≥ 9.8, 80% sensitivity and specificity, AUC = 0.84) in comparison with LA QRS-[Latin Small Letter Open E] (cut-off point ≤ 24.4%, sensitivity = 77%, specificity = 86%, AUC = 0.77) and LA P-[Latin Small Letter Open E] (cut-off point ≤ 26.3%, sensitivity = 64%, specificity = 71%, AUC = 0.77) (Figure).Conclusions: In patients with CHD PWCP correlated with both E/e' ratio and LA strain. However, the diagnostic accuracy of E/e' ratio provided the best diagnostic accuracy of high PCWP.

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