Invasive Validation of the Left Ventricular Global Longitudinal Strain
for Estimating LV Filling Pressure
Abstract
Purpose: An elevated left ventricular (LV) filling pressure is the main
finding in patients with heart failure with preserved ejection fraction,
which is estimated with an algorithm using echocardiographic parameters
recommended by the recent American Society of Echocardiography
(ASE)/European Association of Cardiovascular Imaging (EACVI) guideline.
In this study, we sought to determine the efficacy of LV global
longitudinal strain (GLS) to estimate the elevated LV filling pressure.
Methods and Results: 73 prospectively selected patients undergoing left
ventricular catheterization (mean age 63.19±9.64, 68.5% male)
participated in this study. Using the algorithm, the LV filling pressure
was estimated with the echo parameters obtained within 24hrs before the
catheterization. The LV GLS was measured using the automated functional
imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure
corresponding to mean left atrial pressure (LAP) was used as a
reference, and >12 mm Hg was defined as elevated. The
invasive LV filling pressure was elevated in 43 (58.9%) and normal in
30 patients (41.1%). In 9 (12.3%) patients of 73 are defined as
indeterminate based on the 2016 algorithm. Using the ROC method, -18.1%
of LV GLS estimated the LV filling pressure (AUC=0.79, 73% specificity,
84% sensitivity) with higher sensitivity compared with the algorithm
(AUC=0.76, 77% specificity, 72% sensitivity). Conclusions: We
confirmed that the LV GLS is feasible and reproducible in estimating LV
filling pressure. In addition, LV GLS highly predicts elevated LAP as
E/e’ and TR jet velocity and may be used as major criteria for the
diagnosis of HFpEF