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. 2022 Feb 10:9:822314.
doi: 10.3389/fcvm.2022.822314. eCollection 2022.

A Novel Three-Dimensional and Tissue Doppler Echocardiographic Index for Diagnosing and Prognosticating Heart Failure With Preserved Ejection Fraction

Weiding Wang  1 , Guanyu Mu  1 , Changle Liu  1 , Juan Xie  2 , Hao Zhang  1 , Xiaowei Zhang  1 , Jingjin Che  1 , Gary Tse  1   3   4 , Tong Liu  1 , Guangping Li  1 , Huaying Fu  1
Affiliations

A Novel Three-Dimensional and Tissue Doppler Echocardiographic Index for Diagnosing and Prognosticating Heart Failure With Preserved Ejection Fraction

Weiding Wang et al. Front Cardiovasc Med. .

Abstract

Introduction: The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. In this study, a novel echocardiography index based on three-dimensional and tissue Doppler echocardiography for diagnosing and estimating prognosis in HFpEF.

Materials and methods: Patients with symptoms and/or signs of heart failure and normal left ventricular ejection fraction (LVEF ≥50%) who underwent right heart catheterization were screened. Patients were divided based on pulmonary capillary wedge pressure (PCWP) of ≥15 mmHg and PCWP <15 mmHg. A diagnosis of HFpEF was confirmed by PCWP of ≥15 mmHg according to ESC guidelines. A novel index was calculated by the ratio between stroke volume standardized to body surface area (SVI) and tissue Doppler mitral annulus systolic peak velocity S' (SVI/S'). Its diagnostic and prognostic values were determined.

Results: A total of 104 patients (mean age 64 ± 12 years) were included. Of these, 63 had PCWP ≥15 mmHg and 41 patients had PCWP <15 mmHg. Compared to the PCWP <15 mmHg group, the ≥15 mmHg group had a significantly lower SVI/S' (P < 0.001). Logistic regression showed that SVI/S' was associated with high PCWP measured invasively. The SVI/S' had an area under the curve of 0.761 for diagnosing classifying between PCWP ≥15 mmHg and <15 mmHg. Kaplan-Meier analysis showed that the lower SVI/S' group showed a poorer prognosis.

Conclusions: SVI/S' is a non-invasive index calculated by three-dimensional and tissue Doppler echocardiography. It is a surrogate measure of PCWP and can be used to diagnose and determine prognosis in HFpEF.

Keywords: a novel echocardiography index; diagnosis; heart failure with preserved ejection fraction; prognosis; right heart catheterization.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study selection. HF, heart failure; LVEF, left ventricular ejection fraction; RHC, right heart catheterization; COPD, chronic obstructive pulmonary disease; HFpEF, Heart failure with preserved ejection fraction; PCWP, pulmonary capillary wedge pressure.
Figure 2
Figure 2
ROC analysis showed the SVI/S', E/e', LAVI and NT-proBNP diagnosing ability. SVI/S', the ratio of body surface area standardized stroke volume (SVI) and tissue Doppler mitral annulus systolic peak velocity; E/e', the ratio of early diastolic transmitral velocity to early diastolic septal myocardial velocity; LAVI, left atrial volume index; NT-proBNP, N-terminal pro-brain natriuretic peptide.
Figure 3
Figure 3
Kaplan–Meier curves for the freedom from the primary outcome. SVI/S', the ratio of body surface area standardized stroke volume (SVI) and tissue Doppler mitral annulus systolic peak velocity.
Figure 4
Figure 4
SVI/S' is the initial changing echocardiographic parameter in the process of HFpEF. BNP, brain natriuretic peptide; E/e', the ratio of early diastolic transmitral velocity to early diastolic septal myocardial velocity; HFpEF, heart failure with preserved ejection fraction; LA, left atrium; LAD, left atrial diameter; LAVI, left atrial volume index; LV, left ventricular; SVI/S', the ratio of body surface area standardized stroke volume (SVI) and tissue Doppler mitral annulus systolic peak velocity; TRV, tricuspid regurgitation velocity.
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