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Echocardiographic assessment of left ventricular filling pressure in patients with acute ST elevation myocardial infarction: an invasive validation study

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Abstract

Backgrounds Assessment of left ventricular filling pressure (LVFP) is of clinical importance in patients with ST elevation myocardial infarction (STEMI). Although several echocardiographic parameters are recommended for the assessment of LVFP, validation of these parameters in patients with STEMI is missing. We aimed to investigate the clinical utility of these parameters in acute settings. Methods: We prospectively included consecutive patients with STEMI. LV end-diastolic pressure (LVEDP) was measured following primary PCI and echocardiographic examination was performed within 24 hours. Mean left atrial pressure (mLAP) was calculated both invasively using Yamamoto’s formula and non-invasively using Naugeh’s formula. Mean LAP was considered increased when exceeded 18 mmHg. Results: Patients were grouped according to LVEDP, group 1(41 patients) and group 2(114 patients).There was no significant difference between groups in terms of comorbidities. NT pro-BNP levels (p < 0.001) and peak level of Hs-TnT (p-value: 0.002) were significantly higher in group 2. Average E/e′ ratio was significantly higher in group 2 (10.19 ± 3.15 vs. 12.04 ± 4.83, p: 0.046). Isovolumetric relaxation time was longer in group 2 (p < 0.001) and left atrial volume index (LAVI) was also significantly higher in group 2 (p < 0.001). Regression analyses revealed that septal, lateral and average E/e′ ratio, tricuspid regurgitation velocity, LAVI and left ventricular volume are correlated with mLAP. Among group 2 patients only 14 Patients fulfilled the increased LVFP criteria suggested by current guidelines. Conclusions Echocardiographic parameters indicating increased LVFP require validation and may need to be modified in patients with STEMI. Moreover, current algorithms underestimate the actual number of patients with increased LVFP.

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References

  1. Forrester J, Diamond G, cardiology HS-TA journal of, 1977 undefined Correlative classification of clinical and hemodynamic function after acute myocardial infarction. Elsevier

  2. Weir R, McMurray J, of EV-TA journal, 2006 undefined Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: prevalence, clinical characteristics, and prognostic. Elsevier

  3. Arslan F, Bongartz L, ten Berg JM, Jukema JW, Appelman Y, Liem AH, de Winter RJ, van ’t Hof AWJ, Damman P (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: comments from the Dutch ACS working group. Netherlands Hear J 26:417–421

    Article  CAS  Google Scholar 

  4. Lancellotti P, Galderisi M, Edvardsen T et al (2017) Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. Eur Heart J Cardiovasc Imaging 18:961–968

    Article  Google Scholar 

  5. Bergstra A, Svilaas T, van Veldhuisen DJ, van den Heuvel AFM, van der Horst ICC, Zijlstra F (2007) Haemodynamic patterns in ST-elevation myocardial infarction: incidence and correlates of elevated filling pressures. Neth Heart J 15:95–99

    Article  CAS  Google Scholar 

  6. Nagueh SF, Smiseth OA, Appleton CP et al (2016) Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277–314

    Article  Google Scholar 

  7. Tachjian A, Sanghai SR, Stencel J, Parker MW, Kakouros N, Aurigemma GP (2019) Estimation of Mean Left Atrial Pressure in Patients with Acute Coronary Syndromes: A Doppler Echocardiographic and Cardiac Catheterization Study. J Am Soc Echocardiogr 32:365–374.e1

    Article  Google Scholar 

  8. Thygesen K, Alpert JS, Jaffe AS et al (2018) Fourth universal definition of myocardial infarction&nbsp; Eur Heart J 40:237–269

    Article  Google Scholar 

  9. Zoghbi WA, Adams D, Bonow RO et al (2017) ASE GUIDELINES AND STANDARDS Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. https://doi.org/10.1016/j.echo.2017.01.007

  10. Dokainish H, Nguyen JS, Bobek J, Goswami R, Lakkis NM (2011) Assessment of the American Society of Echocardiography-European Association of Echocardiography guidelines for diastolic function in patients with depressed ejection fraction: an echocardiographic and invasive haemodynamic study. Eur J Echocardiogr 12:857–864

    Article  Google Scholar 

  11. Nagueh S, Middleton K, … HK-J of the, 1997 undefined Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. onlinejacc.org

  12. Yamamoto K, Nishimura RA, Redfield MM (1996) Assessment of mean left atrial pressure from the left ventricular pressure tracing in patients with cardiomyopathies. Am J Cardiol 78:107–110

    Article  CAS  Google Scholar 

  13. Killip T, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A Two year experience with 250 patients. Am J Cardiol 20:457–464

    Article  Google Scholar 

  14. Steg PG, Dabbous OH, Feldman LJ, Cohen-Solal A, Aumont MC, López-Sendón J, Budaj A, Goldberg RJ, Klein W, Anderson FA (2004) Determinants and Prognostic Impact of Heart Failure Complicating Acute Coronary Syndromes: Observations from the Global Registry of Acute Coronary Events (GRACE). Circulation 109:494–499

    Article  Google Scholar 

  15. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133

    Article  Google Scholar 

  16. Gunasekaran R, Maskon O, Hassan HHC, Safian N, Sakthiswary R (2012) Left Atrial Volume Index is an independent predictor of major adverse cardiovascular events in Acute Coronary Syndrome. Can J Cardiol 28:561–566

    Article  Google Scholar 

  17. Moller JE, Hillis GS, Oh JK, Seward JB (2003) Left atrial volume: a powerful predictor of survival after acute myocardial infarction. ACC Curr J Rev 12:39

    Article  Google Scholar 

  18. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey

    Eser Durmaz, Baris Ikitimur, Bilgehan Karadag, Damla Koca, Kardelen Ohtaroglu Tokdil, Utku Raimoglu, Ali Ugur Soysal, Gündüz Incesu, Mehmet Semih Belpinar, Deniz Mutlu & Zeki Ongen

  2. Department of Cardiology, Koc University, Istanbul, Turkey

    Ece Yurtseven

  3. Goztepe Research and Training Hospital, Istanbul, Turkey

    Adem Atici

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  1. Eser Durmaz
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  2. Baris Ikitimur
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Durmaz, E., Ikitimur, B., Karadag, B. et al. Echocardiographic assessment of left ventricular filling pressure in patients with acute ST elevation myocardial infarction: an invasive validation study. Int J Cardiovasc Imaging 37, 1587–1594 (2021). https://doi.org/10.1007/s10554-020-02138-3

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  • DOI: https://doi.org/10.1007/s10554-020-02138-3

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