Echocardiographic Evaluation of Elevated Left Ventricular Filling Pressures in Patients with Obstructive Coronary Artery Disease

Objective: To determine the efficacy of using echocardiography, compared with cardiac catheterization, to diagnose elevated left ventricular filling pressure (LVFP), according to the 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) recommendations, among patients with at least one coronary artery segment presenting stenosis of ≥ 50%. To compare the diagnostic accuracy of the 2009 and 2016 ASE/EACVI guidelines. Methods: Between January and May 2017, a descriptive cross-sectional study was carried out at Cho Ray Hospital in Ho Chi Minh City, Vietnam. The study recruited patients who were undergoing percutaneous coronary angiography. 2D echocardiography and Doppler echocardiography were conducted to estimate LVFP according to the 2009 and 2016 ASE/EACVI recommendations, before inserting a 6F pigtail catheter and undertaking coronary angiography.  Results: 63 patients participated in this study. Their average age was 66.9 ± 11.4 years. 39.7% of patients had LV contraction function of < 50%, and the average LV ejection fraction was 51.0% ± 14.8%. The average LVFP was 19.4 ± 8.5 mmHg, and 50.8% of patients were identified as having elevated LVFP. There was positive correlation between mitral E velocity (r = 0.29), E/A ratio (r = 0.31) and LAVI (r = 0.38) with LVFP (P < 0.05). The accuracy of the 2016 ASE/EACVI for diagnosing LVFP was greater than that of the 2009 version (68.5% and 62.5%, respectively) (Table 5). Conclusions: The 2016 ASE/EACVI recommendations for assessing LVFP are more predictable and clinically useful compared to the 2009 recommendations.