Comparison between Invasive and Echocardiographic Assessment of Left Ventricular Function in Healthy participants

Objectives: Accurate assessment of LV function is of great importance but still challenging. Despite the invasive measure is the gold standard, non-invasive ultrasound is widely used due to its convenience. We aimed to compare the accuracy of several methods assessing LV function in echocardiography. Methods: 49 healthy participants who underwent transthoracic echocardiography and catheterization simultaneously were included. Invasive LVEF and LVFP were measured with Sandler-Dodge method. Non-invasive LV systolic function was measured with both the M-mode method and the modified Simpson method. Parameters related to LV diastolic function in echocardiography including E/A, E/e′, tricuspid regurgitation velocity, left atrial volume index, etc., were measured. Results: Correlations between invasive and non-invasive LVESV, LVEDV, and LVEF were not significant ((P=0.07 and P=0.97, P=0.17 and P=0.74, P=0.64 and P=0.52). Compared to invasive measurements, the modified Simpson method overestimated the LV end-systolic volume (P=0.001), and M-mode method overestimated the LV end-diastolic volume (P=0.047). Both of these two methods underestimated the LVEF (P=0.027 and P16mmHg) had higher A peak velocity (P=0.009) and lower E/A ratio (P=0.001). Multiple linear regression showed that, among all parameters related to LV diastolic function, only E/A significantly associated with LVEDP after adjustment (P=0.006). We further compared the sensitivity and specificity of E/A ,E/e’ and the method recommended by 2016 ASE/EACVI guideline in identifying LV diastolic dysfunction. E/A was with both higher sensitivity and higher specificity in the detection of LVEDP elevation. Conclusions: Both the Simpson method and the M-mode method underestimate the LVEF. In terms of LV diastolic function assessment, E/A ratio is better associated with invasively-measured LVEDP compared to other conventional parameters.