Latest news with #echocardiography
Medscape
10-07-2025
- Health
- Medscape
New Algorithm Improves Echo-Based Heart Pressure Analysis
TOPLINE: A new algorithm for estimating left ventricular filling pressure (LVFP) by echocardiography reduced indeterminate results to just two cases compared with 38 using previous guidelines, achieving 86% accuracy in 949 patients, a new study found. The algorithm showed particular improvement for patients with normal left ventricular ejection fraction (LVEF), while maintaining similar accuracy for cases of reduced LVEF. METHODOLOGY: Researchers conducted an observational study involving 951 patients referred for cardiac catheterization across multiple centers in the United States, Norway, South Korea, Spain, and Japan. The analysis included echocardiographic measurements of mitral inflow; the velocities of the pulmonary vein, tissue Doppler mitral annulus, and tricuspid regurgitation; as well as left atrial strain. LVFP greater than 15 mm Hg was designated as abnormally elevated. A secondary evaluation incorporated left atrial reservoir strain, left atrial maximum volume index, isovolumic relaxation time, and pulmonary vein flow when initial variables were discordant or incomplete. TAKEAWAY: The new algorithm achieved a sensitivity of 86% and a specificity of 86%, with an overall accuracy of 86% in 949 patients, significantly outperforming joint 2016 guidelines from the American Society of Echocardiography and the European Association of Cardiovascular Imaging (P < .0001). For patients with normal LVEF, the algorithm demonstrated 85% sensitivity, 87% specificity, and 86% accuracy, showing significant improvement over previous guidelines (P < .0001). In patients with reduced LVEF, the algorithm had 92% sensitivity, 77% specificity, and 87% accuracy. The model also was more accurate than the guidelines for patients with an ejection fraction of 50% or greater (P < .0001). The net reclassification improvement for echocardiography over natriuretic peptides was 1.1 (P < .0001), with integrated discrimination improvement of 0.3 (P < .0001). IN PRACTICE: 'Application of the new algorithm should result in an increase in the number of patients in whom LV filling pressure can be estimated,' the researchers reported. 'Application of the new algorithm should result in high accuracy in determining LV filling pressure in patients with normal LV ejection fraction. The new algorithm can be combined with natriuretic peptides to correctly identify patients with heart failure.' SOURCE: The study was led by Hossam Lababidi, MD, of Methodist DeBakey Heart and Vascular Center in Houston. It was published online in Circulation. LIMITATIONS: The study did not examine the role of diastolic stress testing, which is recommended for symptomatic patients with grade 1 diastolic dysfunction. The majority of patients also underwent cardiac catheterization for dyspnea evaluation or heart failure management, suggesting the sample had a higher likelihood of elevated LVFP. The researchers noted that accuracy may be lower when applied to populations with lower prevalence of cardiovascular disease. DISCLOSURES: One of the investigators disclosed being a co-inventor of method for myocardial segment work analysis and estimation of blood pressure in the heart and received speaker honorarium from GE HealthCare. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
09-06-2025
- Health
- Medscape
Two-Step Approach Cuts HFpEF Diagnostic Complexity
Assessing left atrial volume and natriuretic peptides (LA/NP) can identify heart failure with preserved ejection fraction (HFpEF) with an 88% specificity and 97% positive predictive value. The strategy reduces the need for additional diagnostics by decreasing intermediate Heart Failure Association pre-test assessment, echocardiography & natriuretic peptide, functional testing, final etiology (HFA-PEFF) or H₂FPEF (Heavy, two or more hypertensive drugs, atrial fibrillation, pulmonary hypertension, elder age > 60 years, elevated filling pressures) algorithm scores by 27%-56%. METHODOLOGY: Researchers developed the diagnostic approach to rule in HFpEF using LA indexed for height 2 (LAViH 2 ; cut-off above 35.5 mL/m 2 in sinus rhythm or above 38.6 mL/m 2 in atrial fibrillation) and natriuretic peptides (as per the HFA-PEFF major criterion) with data from 443 patients with suspected HFpEF and validated in two independent cohorts. (LAViH ; cut-off above 35.5 mL/m in sinus rhythm or above 38.6 mL/m in atrial fibrillation) and natriuretic peptides (as per the HFA-PEFF major criterion) with data from 443 patients with suspected HFpEF and validated in two independent cohorts. End-systolic LA was manually traced in echocardiographic apical four- and two-chamber views and indexed for both body surface area and height 2 , with height 2 -indexed values showing better diagnostic performance in patients with obesity. , with height -indexed values showing better diagnostic performance in patients with obesity. Researchers developed the simplified approach by determining abnormal values for each measure of LA based on the highest value in control individuals, stratified by sinus rhythm/atrial fibrillation, and using elevated natriuretic peptides based on the HFA-PEFF major criterion. TAKEAWAY: The LA/NP approach identified 60% of HFpEF patients with an 88% specificity and a 97% positive predictive value in the derivation cohort, with similar results in the validation cohorts (76%-80% specificity, 92%-97% positive predictive value). The validation cohorts confirmed the LA/NP approach, with a 21%-57% reduction in intermediate scores, demonstrating consistent diagnostic accuracy across different clinical HFpEF profiles. Replacing LAViH2 with LA reservoir strain showed comparable results, suggesting flexibility in the echocardiographic parameters that can be used in this simplified diagnostic approach. IN PRACTICE: 'Using the LA/NP approach as a first step in patients suspected for HfpEF before using the HFA-PEFF or H 2 FPEF algorithm as a second step may substantially reduce the need for additional diagnostics to diagnose HfpEF,' the researchers wrote. SOURCE: The study was led by Jerremy Weerts, MSc, MD, of Maastricht University Medical Center in Maastricht, the Netherlands. It was published online in European Journal of Heart Failure and presented at the Heart Failure Association of the European Society of Cardiology (HFA-ESC) 2025 meeting. LIMITATIONS: The analyses were performed retrospectively in three independent, prospective cohorts from university hospitals, each with a high prevalence of diagnosed HFpEF, which may affect the performance of the LA/NP approach in less selected populations. The use of different natriuretic peptide assays across cohorts limited the derivation of new cut-off values for the LA/NP approach. Right heart catheterization was not performed in all patients, although this reflects daily clinical practice and aligns with large clinical trials in HFpEF. DISCLOSURES: Weerts reported receiving grants from Corvia Medical, CSL Vifor, and Boehringer Ingelheim, unrelated to the submitted work. The study was supported by the Dutch Heart Foundation (grant numbers CVON2017-21-SHE PREDICTS HF and CVON2015-10-Early HFpEF) and the Health Foundation Limburg. Additional disclosures are noted in the original article.
