Echocardiographic assessment of left ventricular filling pressure in patients with acute ST elevation myocardial infarction: an invasive validation study
- 1 May 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in The International Journal of Cardiovascular Imaging
- Vol. 37 (5), 1587-1594
- https://doi.org/10.1007/s10554-020-02138-3
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.This publication has 20 references indexed in Scilit:
- Third Universal Definition of Myocardial InfarctionCVD Prevention and Control, 2012
- Left Atrial Volume Index Is an Independent Predictor of Major Adverse Cardiovascular Events in Acute Coronary SyndromeCanadian Journal of Cardiology, 2012
- Epidemiology of Heart Failure and Left Ventricular Systolic Dysfunction after Acute Myocardial Infarction: Prevalence, Clinical Characteristics, and Prognostic ImportanceThe American Journal of Cardiology, 2006
- Determinants and Prognostic Impact of Heart Failure Complicating Acute Coronary SyndromesCirculation, 2004
- Left atrial volume: a powerful predictor of survival after acute myocardial infarctionACC Current Journal Review, 2003
- Left Atrial VolumeCirculation, 2003
- Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling PressuresCirculation, 2000
- Assessment of mean left atrial pressure from the left ventricular pressure tracing in patients with cardiomyopathiesThe American Journal of Cardiology, 1996
- Correlative classification of clinical and hemodynamic function after acute myocardial infarctionThe American Journal of Cardiology, 1977
- Treatment of myocardial infarction in a coronary care unit: A Two year experience with 250 patientsThe American Journal of Cardiology, 1967