Novel Estimation of Left Ventricular Filling Pressure Using 3-D Speckle-Tracking Echocardiography: Assessment in a Decompensated Systolic Heart Failure Model

Abstract

E/e' allows for the non-invasive estimation of left ventricular (LV) filling pressure; however, Doppler malalignment can make the estimation unreliable, especially in dilated systolic failing hearts. The ratio of peak early diastolic filling rate to peak early diastolic global strain rate (FRe/SRe), which is a parameter derived from 3-D speckle-tracking echocardiography to estimate filling pressure, may be better applied in dilated systolic failing hearts because it can be obtained without the Doppler method. We investigated whether FRe/SRe could provide a better estimation of filling pressure than E/e' in 23 dogs with decompensated systolic heart failure induced by microembolization. FRe/SRe had better correlation coefficients with LV end-diastolic pressure (0.75-0.90) than did E/e' (0.40). The diagnostic accuracy of FRe/SRe in distinguishing elevated filling pressure was significantly higher than that of E/e'. This study indicates that FRe/SRe may provide a better estimation of LV filling pressure than E/e' in dilated systolic failing hearts.

Keywords: Filling pressure; Heart failure; Myocardial strain; Speckle-tracking echocardiography; Three-dimensional.