Diagnostic accuracy of averaged E/e' for the assessment of left ventricular filling pressure

Abstract

Background & Aim: Echocardiography has an important role in the assessment of left ventricular filling pressure, it contributed in transferring from the invasive method during catheterization lab to the noninvasive assessment in a clinic or a hospital. from early studies that tried to link between echo and LV filling pressure, Av E/e' had an important role and was a corner stone in the guidelines that handle with this issue. However, that was without ascertaining the diagnostic accuracy, since there are three different cutoffs in three different guidelines. For that reason, this study tried to validate the correlation between Av E/e' and LV filling pressure and its diagnostic accuracy.

Materials & Methods: In an observational cross-sectional study, 124 patients underwent transthoracic echocardiography immediately before left heart angiography. This study obtained Av E/e' to estimate LV filling pressure as normal, elevated taking in background three different cutoffs: Av E/e'>13 in ESC 2016, Av E/e'>14 in EACVI/ASE 2016 and Av E/e'≥15 in HFA 2019 guidelines. Invasive LV pre-A pressure wave was used as a reference, with >12 mm Hg defined as elevated.

Results: Linear correlation between Av E/e' and LV pre-A was (P=0.0015, r=0.37), diagnostic accuracy for each cutoffs was: (Av E/e'>13: sensitivity=0.40 and specificity=0.92 with P=0.0022 OR=3.12), (Av E/e'>14: sensitivity=0.34 and specificity=0.92 with P=0.0045 OR=2.85) and (Av E/e'≥15: sensitivity=0.28 and specificity=0.92 with P=0.0079 OR=2.45).

Conclusion: Av E/e' had a statistically significant correlation with left ventricular filling pressure. Among the three different cutoffs, Av E/e'>13 (in ESC 2016) was the best cutoff according to the diagnostic accuracy.