Systolic time ratio measured by impedance cardiography accurately screens left ventricular diastolic dysfunction in patients with arterial hypertension

Rodrigo Nazário Leão, Pedro Marques Silva, Luísa Branco, Helena Fonseca, Bruno Bento, Marta Alves, Daniel Virella, Roberto Palma Reis, Rodrigo Nazário Leão, Pedro Marques Silva, Luísa Branco, Helena Fonseca, Bruno Bento, Marta Alves, Daniel Virella, Roberto Palma Reis

Abstract

Background: The use of impedance cardiography (ICG) may play a role in the assessment of cardiac effects of hypertension (HT), especially its hemodynamic features. Hypertensive heart disease involves structural changes and alterations in left ventricular geometry that end up causing systolic and/or diastolic dysfunction. The IMPEDDANS study aims to assess the usefulness of ICG for the screening of left ventricular diastolic dysfunction (LVDD) in patients with HT.

Methods: Patients with HT were assessed by echocardiography and ICG. Receiver-operating characteristic curve and the area under the curve were used to assess the discriminative ability of the parameters obtained by ICG to identify LVDD, as diagnosed by echocardiography.

Results: ICG derived pre-ejection period (PEP), left ventricle ejection time (LVET), systolic time ratio (STR) and D wave were associated (p < 0.001) with LVDD diagnosis, with good discriminative ability: PEP (AUC 0.81; 95% CI 0.74-0.89), LVET (AUC 0.82; 95% CI 0.75-0.88), STR (AUC 0.97; 95% CI 0.94-1.00) and presence of D wave (AUC = 0.87; 95% CI 0.82-0.93). STR ≥ 0.30 outperformed the other parameters (sensitivity of 98.0%, specificity of 90.2%, positive predictive value of 95.2%, and negative predictive value of 96.1%).

Conclusion: The ICG derived value of STR allows the accurate screening of LVDD in patients with HT. It might as well be used for follow up assessment.

Trial registration: The study protocol was retrospectively registered as IMPEDDANS on ClinicalTrials.gov (ID: NCT03209141) on July 6, 2017.

Keywords: Arterial hypertension; Diastolic dysfunction; Impedance Cardiography; Screening; Systolic time ratio.

Conflict of interest statement

The study protocol was approved by the hospital’s Ethics Committee (approval number 166/2014). Informed consent was obtained from each patient.Patients gave consent to publication.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
ICG waves in diastolic dysfunction (adapted from Bour et al. [5])
Fig. 2
Fig. 2
Practical approach to grade diastolic dysfunction (adapted from Nagueh et al. [25])
Fig. 3
Fig. 3
Distribution of the values of (a) pre-ejection period (PEP), b left ventricle ejection time (LVET), c systolic time ratio (STR) and d thoracic fluid content (TFC), as assessed by ICG, according with the diagnosis of LVDD (left ventricular diastolic dysfunction) by echocardiography. Graphics represent the interquartile range (P25-P75), median, limits and outliers. Comparison by Mann-Whitney test
Fig. 4
Fig. 4
Discriminative ability of PEP, LVET, STR and D wave to identify LVDD in hypertensive patients, as determined by the AUC and ROC curves. STR AUC = 0.97; PEP AUC = 0.81; LVET AUC = 0.82; D Wave AUC = 0.88. AUC, area under the curve; LVDD, left ventricular diastolic dysfunction; LVET, left ventricle ejection time; PEP, pre-ejection period; STR, systolic time ratio
Fig. 5
Fig. 5
Practical approach to diagnose diastolic dysfunction (adapted from Nagueh et al. [31])

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