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

Weiding Wang; Guanyu Mu; Changle Liu; Juan Xie; Hao Zhang; Xiaowei Zhang; Jingjin Che; Gary Tse; Tong Liu; Guangping Li; Huaying Fu

doi:10.3389/fcvm.2022.822314

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

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

Authors

Weiding Wang¹, Guanyu Mu¹, Changle Liu¹, Juan Xie², Hao Zhang¹, Xiaowei Zhang¹, Jingjin Che¹, Gary Tse^{1

3

4}, Tong Liu¹, Guangping Li¹, Huaying Fu¹

Affiliations

¹ Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China.
² School of Public Health, Tianjin Medical University, Tianjin, China.
³ Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
⁴ Kent and Medway Medical School, Canterbury, United Kingdom.

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.