AUTHOR=Palka Przemysław , Hilling-Smith Roland , Swann Rohan , Allwood Sean , Moore Alexander , Bian Chris , Lange Aleksandra 

TITLE=Left ventricular to left arial volume ratio in the assessment of filling pressure in patients with dyspnoea and preserved ejection fraction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1357006

DOI=10.3389/fcvm.2024.1357006

ISSN=2297-055X

ABSTRACT=Introduction: Assessing filling pressure (FP) remains a clinical challenge despite non-invasive imaging advancements. This study investigates the utility of echocardiographic left ventricular (LV) to left atrial (LA) volume ratio in estimating resting FP in patients with dyspnoea and preserved ejection fraction (EF).
Methods: In this prospective, single centre study, fifty-three consecutive patients with dyspnoea (New York Heart Association grade 2 or 3) and LVEF ≥50% (mean age 71±10 years) who underwent cardiac catheterisation, including direct, at rest, retrograde LA pressure measurement were analysed. Echocardiographic data was obtained 1.5±1.0 hours off cardiac catheterisation.  Patients were divided into: Group 1 - elevated FP with mean LA pressure or mean pulmonary capillary wedge pressure >12 mmHg and Group 2 - normal FP. The LV and LA volumes were measured at the minimum (LVES, LAmin), diastasis (LVdias, LAdias) and in the maximum (LVED, LAmax). The corresponding LV/LA volume ratio were analysed: end-systole (LVES/LAmax), diastasis (LVdias/LAdias), and in end-diastole (LVED/LAmin). 
Results: Patients in Group 1 as compared to Group 2 had lower LV/LA volume ratios (LVES/LAmax 0.44±0.12 versus 0.60±0.23, P=0.0032; LVdias/LAdias  1.13±0.30 versus 1.56±0.49, P=0.0007; LVED/LAmin 2.71±1.57 versus 4.44±1.70, P=0.0004). LV/LA volume ratios correlated inversely with an increased FP (LVES/LAmax, r=-0.40, P=0.0033; LVdias/LAdias, r=-0.45, P=0.0007; LVED/LAmin, r=-0.55, P<0.0001). Among all the measurements, LVdias/LAdias ratio demonstrated the highest discriminatory power to distinguish patients with elevated from normal FP, with a cut-off value at ≤1.24 (area under the curve-AUC=0.822 ) for the entire group encompassing both sinus rhythm and atrial fibrillation. For patients in sinus rhythm specifically, the cut-off value was ≤1.28 (AUC=0.799) with P<0.0001 for both.  The LVdias/LAdias index demonstrated non-inferiority to the E/e’ ratio (ΔAUC=0.159, confidence interval -CI=-0.020-0.338; P=0.0809),  while surpassing the indices of  LA reservoir function (ΔAUC=0.249, CI=0.044-0.454; P=0.0176), LA reservoir strain (ΔAUC=0.333, CI=0.149-0.517; P=0.0004), and LAmax index (ΔAUC=0.224, CI=0.043-0.406; P=0.0152) in diagnosing patients with elevated FP.
Conclusion: The study presents a straightforward  and reproducible method for non-invasive estimation of FP using routine TTE in patients with dyspnoea and preserved EF. The LVdias/LAdias index emerges as a promising indicator for identifying elevated FP, demonstrating comparable to or even superior performance to established parameters.