Background: Invasive measurement of left ventricular filling pressure is the gold standard for determining diastolic dysfunction and predicting subsequent outcomes. For repetitive assessment of diastolic function during long-term management, noninvasive surrogates are used. Their reliability and reproducibility should be validated separately for different cardiovascular diseases and conditions. The aim of this study was to identify noninvasive surrogates of invasively derived left ventricular filling pressure and to relate these surrogates to outcomes (death or valve replacement) in patients with stable, asymptomatic valvular heart disease and preserved ejection fraction. Materials and Methods: In a first cohort, we investigated 54 patients who had spiroergometry, echocardiography, and left heart catheterization within a range of 100 days. In a second cohort (n = 64), noninvasive measures were related to outcomes after follow-up of 694 ± 576 days. Transmitral doppler E/tissue doppler E’ (E/E’), E/flow propagation velocity (E/Vp), isovolumetric relaxation time/time to E’-time to E (IVRT/TE’-TE), ventilatory efficiency (VE/VCO 2 slope), O 2 consumption at anaerobic threshold and at peak exercise (VO2AT, VO2peak) as well as NT-pro brain natriuretic peptide (NTpro-BNP) were assessed in relation to left ventricular filling pressure and outcome. Results: NT-proBNP, VO 2 AT, VE/VCO 2 slope as well as echocardiographic surrogates E/E’ and E/flow propagation velocity were indicators of elevated end diastolic filling pressure. In multivariable analysis, VO 2 AT was the only independent predictor. NT-proBNP was the only surrogate of left ventricular filling pressure which predicted outcome. Conclusion: In patients with asymptomatic valvular heart disease and preserved systolic function, spiroergometric parameters and NT-proBNP performed best to assess filling pressure. Only NT-proBNP showed prognostic value in this cohort.
Halley, C.M., Houghtaling, P.L., Khalil, M.K., Thomas, J.D. and Jaber W.A. (2011) Mortality Rate in Patients with Diastolic Dysfunction and Normal Systolic Function. Archives of Internal Medicine, 171, 1082-1087. http://dx.doi.org/10.1001/archinternmed.2011.244
Owan, T.E., Hodge, D.O., Herges, R.M., Jacobsen, S.J., Roger, V.L. and Redfield, M.M. (2006) Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction. The New England Journal of Medicine, 355, 251-259. http://dx.doi.org/10.1056/NEJMoa052256
Moller, J.E., Pellikka, P.A., Hillis, G.S. and Oh, J.K. (2006) Prognostic Importance of Diastolic Function and Filling Pressure in Patients with Acute Myocardial Infarction. Circulation, 114, 438-444. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.601005
Bhella, P.S., Pacini, E.L., Prasad, A., Hastings, J.L., Adams-Huet, B., Thomas, J.D., Grayburn, P.A. and Levine, B.D. (2011) Echocardiographic Indices Do Not Reliably Track Changes in Left-Sided Filling Pressure in Healthy Subjects or Patients with Heart Failure with Preserved Ejection Fraction. Circulation: Cardiovascular Imaging, 4, 482-489. http://dx.doi.org/10.1161/CIRCIMAGING.110.960575
Mullens, W., Borowski, A.G., Curtin, R.J., Thomas, J.D. and Tang, W.H. (2009) Tissue Doppler Imaging in the Estimation of Intracardiac Filling Pressure in Decompensated Patients with Advanced Systolic Heart Failure. Circulation, 119, 62-70. http://dx.doi.org/10.1161/CIRCULATIONAHA.108.779223
Maeder, M.T., Thompson, B.R., Brunner-La Rocca, H.P. and Kaye, D.M. (2010) Hemodynamic Basis of Exercise Limitation in Patients with Heart Failure and Normal Ejection Fraction. Journal of the American College of Cardiology, 56, 855-863. http://dx.doi.org/10.1016/j.jacc.2010.04.040
Skaluba, S.J. and Litwin, S.E. (2004) Mechanisms of Exercise Intolerance: Insights from tissue Doppler Imaging. Circulation, 109, 972-977. http://dx.doi.org/10.1161/01.CIR.0000117405.74491.D2
Nagueh, S.F., Appleton, C.P., Gillebert, T.C., Marino, P.N., Oh, J.K., Smiseth, O.A., Waggoner, A.D., Flachskampf, F.A., Pellikka, P.A. and Evangelisa, A. (2009) Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography. European Heart Journal, 10, 165-193. http://dx.doi.org/10.1093/ejechocard/jep007
Lancellotti, P., Magne, J., Donal, E., O’Connor, K., Dulgheru, R., Rosca, M. and Pierard, L.A. (2012) Determinants and Prognostic Significance of Exercise Pulmonary Hypertension in Asymptomatic Severe Aortic Stenosis. Circulation, 126, 851-859. http://dx.doi.org/10.1161/CIRCULATIONAHA.111.088427
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Schulz, O., Brala, D., Bensch, R., Kramer, J., Schulz-Menger, J., Berghoefer, G. and Schimke, I. (2012) Aortic Valve Replacement in Asymptomatic and Symptomatic Patients with Preserved Left Ventricular Ejection Fraction. The Journal of Heart Valve Disease, 21, 576-583.
Zoghbi, W.A., Enriquez-Sarano, M., Foster, E., Graburn, P.A., Kraft, C.D., Levine, R.A., Nihoyannopoulos, P., Otto, C.M., Quinones, M.A., Rakowski, H., Stewart, W.J., Waggoner, A. and Weissman, N.J. (2003) Recommendations for Evaluation of the Severity of Native Valvular Regurgitation with Two-Dimensional and Doppler Echocardiography. Journal of the American Society of Echocardiography, 16, 777-802. http://dx.doi.org/10.1016/S0894-7317(03)00335-3
Rivas-Gotz, C., Khoury, D.S., Manolios, M., Rao, L., Kopelen, H.A. and Nagueh, S.F. (2003) Time Interval between Onset of Mitral Inflow and Onset of Early Diastolic Velocity by Tissue Doppler: A Novel Index of Left Ventricular Relaxation: Experimental Studies and Clinical Application. Journal of the American College of Cardiology, 42, 1463-1470. http://dx.doi.org/10.1016/S0735-1097(03)01034-9
Tabet, J.Y., Beauvais, F., Thabut, G., Tartiere, J.M., Logeart, D. and Cohen-Solal, A. (2003) A Critical Appraisal of the Prognostic Value of the VE/VCO2slope in Chronic Heart Failure. European Journal of Cardiovascular Prevention and Rehabilitation, 10, 267-272.
Gulati, M., Black, H.R., Shaw, L.J., Arnsdorf, M.F., Merz, C.N., Lauer, M.S., Marwick, T.H., Pandey, D.K., Wicklund, R.H. and Thisted, R.A. (2005) The Prognostic Value of a Nomogram for Exercise Capacity in Women. New England Journal of Medicine, 353, 468-475. http://dx.doi.org/10.1056/NEJMoa044154
Omland, T., Sabatine, M.S., Jablonski, K.A., Rice, M.M., Hsia, J., Wergeland, R., Landaas, S., Rouleau, J.L., Domanski, M.J., Hall, C., Pfeffer, M.A. and Braunwald, E. (2007) Prognostic Value of B-Type Natriuretic Peptides in Patients with Stable Coronary Artery Disease: The PEACE Trial. Journal of the American College of Cardiology, 50, 205-214. http://dx.doi.org/10.1016/j.jacc.2007.03.038
Dini, F.L., Ballo, P., Badano, L., Barbier, P., Chella, P., Conti, U., De Tommasi, S.M., Galderisi, M., Ghio, S., Magagnini, E., Pieroni, A., Rossi, A., Rusconi, C. and Temporelli, P.L. (2010) Validation of an Echo-Doppler Decision Model to Predict Left Ventricular Filling Pressure in Patients with Heart Failure Independently of Ejection Fraction. European Heart Journal—Cardiovascular Imaging, 11, 703-710. http://dx.doi.org/10.1093/ejechocard/jeq047
Firstenberg, M.S., Levine, B.D., Garcia, M.J., Greenberg, N.L., Cardon, L., Morehead, A.J., Zuckerman, J. and Thomas, J.D. (2000) Relationship of Echocardiographic Indices to Pulmonary Capillary Wedge Pressures in Healthy Volunteers. Journal of the American College of Cardiology, 36, 1664-1669. http://dx.doi.org/10.1016/S0735-1097(00)00909-8
Ommen, S.R., Nishimura, R.A., Appleton, C.P., Miller, F.A., Oh, J.K., Redfield, M.M. and Tajik, A.J. (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. http://dx.doi.org/10.1161/01.CIR.102.15.1788
Hillis, G.S., Moller, J.E., Pellikka, P.A., Gersh, B.J., Wright, R.S., Ommen, S.R., Reeder, G.S. and Oh, J.K. (2004) Noninvasive Estimation of Left Ventricular Filling Pressure by E/E’ Is a Powerful Predictor of Survival after Acute Myocardial Infarction. Journal of the American College of Cardiology, 43, 360-367. http://dx.doi.org/10.1016/j.jacc.2003.07.044
Kasner, M., Westermann, D., Steendijk, P., Gaub, R., Wilkenshoff, U., Weitmann, K., Hoffmann, W., Poller, W., Schultheiss, H.P., Pauschinger, M. and Tschope, C. (2007) Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Diastolic Function in Heart Failure with Normal Ejection Fraction: A Comparative Doppler-Conductance Catheterization Study. Circulation, 116, 637-647. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.661983
Vasan, R.S. (2004) Expanding Indications for Natriuretic Peptides: Importance of Better New (Research) Protocols. American Heart Journal, 148, 743-746. http://dx.doi.org/10.1016/j.ahj.2004.04.044
O’Neill, J.O., Bott-Silverman, C.E., McRae III, A.T., Troughton, R.W., Ng, K., Starling, R.C. and Young, J.B. (2005) B-Type Natriuretic Peptide Levels Are Not a Surrogate Marker for Invasive Hemodynamics during Management of Patients with Severe Heart Failure. American Heart Journal, 149, 363-369. http://dx.doi.org/10.1016/j.ahj.2004.05.051
Min, P.K., Ha, J.W., Jung, J.H., Choi, E.Y., Choi, D., Rim, S.J., Jang, Y., Shim, W.H., Cho, S.Y. and Chung, N. (2007) Incremental Value of Measuring the Time Difference between Onset of Mitral Inflow and Onset of Early Diastolic Mitral Annulus Velocity for the Evaluation of Left Ventricular Diastolic Pressures in Patients with Normal Systolic Function and an Indeterminate E/E’. American Journal of Cardiology, 100, 326-330. http://dx.doi.org/10.1016/j.amjcard.2007.02.102
Gitt, A.K., Wasserman, K., Kilkowski, C., Kleemann, T., Kilkowski, A., Bangert, M., Schneider, S., Schwarz, A. and Senges, J. (2002) Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death. Circulation, 106, 3079-3084. http://dx.doi.org/10.1161/01.CIR.0000041428.99427.06
Weber, M., Hausen, M., Arnold, R., Nef, H., Moellmann, H., Berkowitsch, A., Elsaesser, A., Brandt, R., Mitrovic, V. and Hamm, C. (2006) Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide for Conservatively and Surgically Treated Patients with Aortic Valve Stenosis. Heart, 92, 1639-1644. http://dx.doi.org/10.1136/hrt.2005.085506
Monin, J.L., Lancellotti, P., Monchi, M., Lim, P., Weiss, E., Piérard, L. and Gueret, P. (2009) Risk Score for Predicting Outcome in Patients with Asymptomatic Aortic Stenosis. Circulation, 120, 69-75. http://dx.doi.org/10.1161/CIRCULATIONAHA.108.808857
Olson, J.J., Costa, S.P., Young, C.E. and Palac, R.T. (2006) Early Mitral Filling/Diastolic Mitral Annular Velocity Ratio Is Not a Reliable Predictor of Left Ventricular Filling Pressure in the Setting of Severe Mitral Regurgitation. Journal of the American Society of Echocardiography, 19, 83-87. http://dx.doi.org/10.1016/j.echo.2005.07.005
Diwan, A., McCulloch, M., Lawrie, G.M., Reardon, M.J. and Nagueh, S.F. (2005) Doppler Estimation of Left Ventricular Filling Pressures in Patients with Mitral Valve Disease. Circulation, 111, 3281-3289. http://dx.doi.org/10.1161/CIRCULATIONAHA.104.508812