Abstract 11563: Echocardiographic Characteristics of Patients With Heart Failure and Preserved Ejection Fraction: Noninvasive Assessment by 3-dimensional Speckle Tracking Echocardiography

Introduction:Underlying pathophysiology in heart failure with preserved left ventricular (LV) ejection fraction (HFpEF) involves a predominant abnormality in diastolic function. LV relaxation (eTau) and pulmonary capillary wedge pressure (ePCWP) are noninvasively estimated by speckle tracking echocardiography (STE). LV camber stiffness may be evaluated with the use of 2 diastolic pressure-volume coordinates: the minimum diastolic pressure (mP) that has a strong correlation with Tau and volume, and the end-diastolic pressure (EDP) and volume.Methods:STE was performed in 51 controls (age 66?11), 57 hypertensive patients (HTN) without hypertrophy (LVH) (68?11), 69 HTN with LVH (71?11) and 39 HFpEF (77?14). The ePCWP was calculated as 10.8 - 12.4 Log (active LAEF / minimum LAV) (KT index) and eEDP was estimated as 12.3 - 10.1 x KT index. Tau was calculated as isovolumic relaxation time / (ln 0.9 x systolic blood pressure - ln PCWP). LV estimated myocardial stiffness (e-m-stiffness) was obtained as LVED stress / LV strain by 3D-STE, LV chamber stiffness (mmHg/ml) was calculated as LV pressure change (from mP to EDP) obtained by catheterization divided by LV volume change during diastole. Estimated chamber-stiffness (e-c-stiffness) was obtained using e-mP and e-EDP. LV stiffness and mP by STE were validated by catheterization (n=126).Results:The e-c-stiffness, e-m-stiffness and e-mP by STE had a good correlation with those by catheterization (r=0.64, 0.89 and 0.70, respectively, p<0.01). The e-mP had a good correlation with Tau (r=0.70, p<0.01). Multivariate analysis revealed that ePCWP and e-c-stiffness were independent predictors of HFpEF. Using ePCWP cutoff of 11, sensitivity and specificity for HFpEF is 82 and 82% with AUC of 0.89. Using e-c-stiffness cutoff of 0.25, sensitivity and specificity is 72 and 82% with AUC of 0.84.Conclusion:LV diastolic function including LV stiffness may be noninvasively assessed by STE and echo features of HFpEF could be evaluated.