Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT)

1612JACC April 5, 2016

Volume 67, Issue 13

LEFT ATRIAL TO LEFT VENTRICULAR END SYSTOLIC VOLUME INDEX RATIO BY ECHOCARDIOGRAPHY CAN PREDICT ELEVATED LEFT ATRIAL PRESSURE IN HEART FAILURE WITH PRESERVED EJECTION FRACTION

Poster ContributionsPoster Area, South Hall A1Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m.

Session Title: Novel Echocardiographic Methods for Evaluating Cardiac FunctionAbstract Category: 29. Non Invasive Imaging: EchoPresentation Number: 1111-268

Authors: Amarbir Bhullar, Manminder Bhullar, Manmeet Singh, Kamil Muhyieddeen, Bhavik Khatri, Ryan Berg, Enrique Carbajal, Chandra Katikireddy, UCSF Fresno, Fresno, CA, USABackground: Our aim was to determine if an increased left atrium (LA) to left ventricle (LV) size ratio in end systole (ventricular) on 2D echocardiography (Echo) is a marker of elevated LA pressure (LAP) in heart failure with preserved ejection fraction (HFPEF), as LA is relatively dilated and LV cavity size is reduced from remodeling and hypertrophy.Methods: We retrospectively identified 35 consecutive HFPEF subjects with elevated LAP (>15 mmHg) as confirmed by right heart catheterization and 40 controls with normal LAP. Significant mitral valve disease and atrial fibrillation were excluded. We examined the clinical characteristics and Echo variables including chamber morphology, LA/LV end systolic volume index ratio (ESVIR, biplane method) and other markers of LAP such as LA ESVI, E/e’.Results: No significant difference was noted among the demographics and clinical variables between the two groups except for increased CAD prevalence (p=0.02) in HFPEF. In multivariate analysis, LA/LV ESVIR >1.2 was found to be the strongest and only independent Echo predictor of elevated LAP (p=<0.001). On ROC analysis (figure), compared to lateral E/e’ (>12) and LA ESVIR (>34ml/m2), LA/LV ESVIR had a superior diagnostic sensitivity (74%, 40%, 94% respectively) and comparable specificity (73%, 90%, 71%) in predicting increased LAP.Conclusions: LA/LV ESVIR >1.2 on Echo is a powerful predictor of elevated LAP in HFPEF. This can be used as a complementary noninvasive measure to detect elevated LAP in HFPEF.