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Evaluation of Left Ventricular Stiffness with Echocardiography
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  • Chuan Wang ,
  • Nanjun Zhang,
  • Linling Zhang,
  • Liting Tang,
  • Shuran Shao,
  • Qinhui Wang,
  • Li Zhao,
  • Yimin Hua,
  • Xiaoliang Liu,
  • Kaiyu Zhou
Chuan Wang
Sichuan University West China Second University Hospital

Corresponding Author:[email protected]

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Nanjun Zhang
Sichuan University West China Second University Hospital
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Linling Zhang
Sichuan University West China Second University Hospital
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Liting Tang
Sichuan University West China Second University Hospital
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Shuran Shao
Sichuan University West China Second University Hospital
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Qinhui Wang
Sichuan University West China Second University Hospital
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Li Zhao
Sichuan University West China Second University Hospital
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Yimin Hua
Sichuan University West China Second University Hospital
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Xiaoliang Liu
Sichuan University West China Second University Hospital
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Kaiyu Zhou
Sichuan University West China Second University Hospital
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Abstract

Half of patients with heart failure are presented with preserved ejection fraction (HFpEF). The pathophysiology of these patients is complex but increased left ventricular (LV) stiffness is proved to play a key role. However, the application of this parameter was limited since its measurements requires invasive catheterization. With advances in ultrasound technology, new advances have been achieved in the assessment of LV chamber or myocardial stiffness using noninvasive echocardiography. Therefore, this review was carried out to summarize the pathophysiological mechanisms, correlations with invasive LV stiffness constant, applications in different populations as well as the limitations of echocardiography-derived indices for assessment of both LV chamber and myocardial stiffness. LV chamber stiffness indices such as E/e’/LVEDV, E/SRe/LVEDV, and DPVQ were derived on the basis of the relationship between echocardiographic parameters of LVFP and LV size. However, all these methods are surrogate and lumped measurements, relying on E/e’ or E/SRe for evaluating LVFP. The limitations of E/e’ or E/SRe in assessment of LVFP may contribute to the moderate correlation between E/e’/LVEDV or E/SRe/LVEDV and LV stiffness constant. Even the best validated measurement (DPVQ) is considered unreliable in the individual patient. Compared to E/e’/LVEDV and E/SRe/LVEDV, I PVA/IA and F PVA/FA may display better performance in assessing LV chamber stiffness as evidenced by a higher correlation with LV stiffness constant. However, only one study has been conducted in the literature on the exploration and application of I PVA/I A and F PVA/F A, and its accuracy in assessing LV chamber stiffness remains to be confirmed. In terms of echocardiographic indices for LV myocardial stiffness evaluation, the parameters of EMI/DWS, iVP and SWI were proposed. Despite alteration of DWS and its predictive value of adverse outcomes in various populations have been widely validated, it was found that DWS may be better considered as an overall marker of cardiac function performance instead of pure myocardial stiffness. As for the iVP and SWI, the validities of these two indices in assessing LV myocardial stiffness have not been confirmed in invasive studies. More echocardiographic indices with higher sensitivities and specificities warrant to be further uncovered to evaluate LV stiffness.
12 Apr 2023Submitted to Echocardiography
12 Apr 2023Submission Checks Completed
12 Apr 2023Assigned to Editor
18 Apr 2023Reviewer(s) Assigned
08 May 2023Review(s) Completed, Editorial Evaluation Pending
12 May 2023Editorial Decision: Revise Major
15 Aug 20231st Revision Received
21 Aug 2023Assigned to Editor
21 Aug 2023Submission Checks Completed
21 Aug 2023Reviewer(s) Assigned
05 Sep 2023Review(s) Completed, Editorial Evaluation Pending
25 Sep 2023Editorial Decision: Revise Major
06 Oct 20232nd Revision Received
06 Oct 2023Assigned to Editor
06 Oct 2023Submission Checks Completed
06 Oct 2023Reviewer(s) Assigned
20 Oct 2023Review(s) Completed, Editorial Evaluation Pending
22 Nov 2023Editorial Decision: Revise Minor