| Abstract: |
Background: Left ventricular heart failure in the setting of a preserved left ventricular ejection fraction constitutes up to 50% of heart failure, increases with age, is correlated with the presence of systemic hypertension and left ventricular hypertrophy, and has significant morbidity and mortality, approaching that of systolic heart failure . Coronary artery disease is considered as the most common cause of morbidity and mortality worldwide, which results as the consequence of many complications such as ventricular dysfunction or hemodynamic problems. In patients with ischemic heart disease, evaluation of the left ventricular end diastolic pressure (LVEDP) provides the assessment of hemodynamic severity and aids the proper management and therapeutic interventions. LVEDP is considered as an important factor in evaluating cardiac dysfunction and can be assessed by different techniques, including both invasive (cardiac catheterization) and noninvasive (echocardiography) approaches. The main advantage of Doppler measurements is their ability to calculate hemodynamic indices noninvasively.Aim of the work: To assess the validity of early diastolic driving force as a new index for prediction of left ventricular end diastolic pressure and compare it with E/E´ratio by tissue Doppler imaging, using left ventricular end diastolic pressure measured by cardiac catheterization as a reference. Early diastolic driving force (DF) is derived from Newton’s second law of motion: force = mass× acceleration. Mass was calculated from mitral diastolic velocity time integral and cross sectional area from 220 / p1/2 time Patents&Methods: This study was carried out in cardiology department, Zagazig University. This study included (100) subjects underwent coronary angiography & left sided heart catheterization to measure left ventricular end diastolic pressure. These patients included 60 male (60 %) and 40 female (40%), their ages ranged from 33 to 73 years, Eighty nine patients were > 65 years old and eleven patients were ≥ 65years old, careful history was taken, risk factors were identified, and left ventricular end diastolic pressure was measured invasively. In all patients, full echocardiographic examination was done, left ventricular ejection fraction was measured using modified biplane method of Simpson , transmitral flow Doppler from which early diastolic driving force (DF) was calculated (DF = 0.004E²/DT) and tissue Doppler on mitral annulus (septal , lateral) was done, E/E’ ratio was calculated and compared with invasive LVEDP measurement Results: The study showed high sensitivity (94.1%), specifity (86.7%) and accuracy (93%) of early diastolic driving force (DF) in prediction of LVEDP 0.001**), so it can be used as a predictor for left ventricular end diastolic pressure. We found that DF is more sensitive than E/E´-S(septal) and E/E´-L(lateral) (94.1% vs 58.8, 72,9%) , has equal specifity of E/E´-S (86.7%) , But less specific than E/E´-L(86.7% > 93.3%) , Thus DF is more accurate than E/E´-S and E/E´-L ( 93% < 63%,76%) in prediction of LVEDP. ROC analysis yielded an optimal DF cutoff value of 0.1 newton for prediction of LVEDP >16mmHg. The study showed high sensitivity, specifity and accuracy of E/E´- L, E/E´- S in prediction of left ventricular end diastolic pressure, but E/E´-L was more sensitive and specific than E/E´-S in prediction of LVEDP. The study showed low sensitivity (14.1%), specifity (33.3%) and accuracy (17%) of EF in prediction of LVEDP, so it cannot be used as a predictor for LVEDP. The study showed positive highly significant correlation between LVEDP & E/E´- S, positive highly significant correlation between LVEDP & E/E´- L and negative highly significant correlation between LVEDP & DF.It was shown that there is statistically significant relation between hypertension (P=0.04*), diabetes mellitus (P=0.005*) and LVEDP. It was shown that there is no statistically significant relation between gender (P=0.67), age (P=0.83), smoking (P=0.55) and LVEDP Conclusion: The assessment of diastolic function is now essential on routine testing for HF. The noninvasive nature of echocardiography has allowed an increase in diagnosis and awareness of diastolic dysfunction. We recommend to use early diastolic driving force (DF) as a reliable parameter during echocardiographic evaluation of any patient with dyspnea and suspected diastolic dysfunction as this model would allow better assessment of elevated LVEDP and can guide therapeutic maneuvers more accurately without subjecting patients to the risks and complications of invasive procedures. Also, Measurement of E/E´-S and E/E´-L should be a routine as a part of diagnosis of diastolic dysfunction as they have a direct correlation to left ventricular end diastolic pressure measured invasively. It is recommended to perform further studies on a larger sector of patients to test the validity of early diastolic driving force in non ischemic patients as patients with restrictive diastolic dysfunction Key words: LVEDP (left ventricular end diastolic pressure), p1/2 time (pressure half time), DF (early diastolic driving force), ROC (receiver operating characteristics), EF (ejection fraction Corresponding author. E-mail address: dr.islam_2010@yahoo.com . (Islam Ghanem Cardiology Department, Faculty of Medicine, Zagazig University.
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