Noninvasive Surrogates for Left Ventricular Filling Pressure in Patients with Valvular Heart Disease

Background: Invasive measurement of left ventricular filling pressure is the gold standard for determining diastolic dysfunction and predicting subsequent outcomes. For repetitive assessment of diastolic function during long-term management, noninvasive surrogates are used. Their reliability and reproducibility should be validated separately for different cardiovascular diseases and conditions. The aim of this study was to identify noninvasive surrogates of invasively derived left ventricular filling pressure and to relate these surrogates to outcomes (death or valve replacement) in patients with stable, asymptomatic valvular heart disease and preserved ejection fraction. Materials and Methods: In a first cohort, we investigated 54 patients who had spiroergometry, echocardiography, and left heart catheterization within a range of 100 days. In a second cohort (n = 64), noninvasive measures were related to outcomes after follow-up of 694 ± 576 days. Transmitral doppler E/tissue doppler E’ (E/E’), E/flow propagation velocity (E/Vp), isovolumetric relaxation time/time to E’-time to E (IVRT/TE’-TE), ventilatory efficiency (VE/VCO2slope), O2 consumption at anaerobic threshold and at peak exercise (VO2AT, VO2peak) as well as NT-pro brain natriuretic peptide (NTpro-BNP) were assessed in relation to left ventricular filling pressure and outcome. Results: NT-proBNP, VO2AT, VE/VCO2slope as well as echocardiographic surrogates E/E’ and E/flow propagation velocity were indicators of elevated end diastolic filling pressure. In multivariable analysis, VO2AT was the only independent predictor. NT-proBNP was the only surrogate of left ventricular filling pressure which predicted outcome. Conclusion: In patients with asymptomatic valvular heart disease and preserved systolic function, spiroergometric parameters and NT-proBNP performed best to assess filling pressure. Only NT-proBNP showed prognostic value in this cohort.