Similarly,
New algorithm improves estimate left:
The precise determination of the filling pressures of the left ventricle (LVFP) is essential during the evaluation of patients with dyspnea. Consequently, in particular to differentiate the cardiac causes from other etiologies. In addition, Until now. For example, the recommendations published in 2016 have had significant limits, because in a considerable proportion of cases, the diagnosis remained indeterminate. Moreover, In order to exceed this limit. For example, a multicenter validation study published in Circulation Evaluated a new non -invasive estimate algorithm by transthoracic echocardiography.
Design. Furthermore, characteristics of the observational study
The study included 951 patients from several centers in the United States, Norway, South Korea, Spain and Japan were addressed for cardiac catheterization, considered the reference for direct intracardiac pressure. However, In all cases. Consequently, detailed echocardiographic measurements have been carried out, including traditional parameters such as the Matral new algorithm improves estimate left wave speed and tricuspid regurgitation, as well as advanced measures of deformation of the left ventricle and the left atrium.
The algorithm offers a two hierarchical approach with objective criteria to classify the LVFP as normal or high (> 15 mm HG).
Two hierarchical steps to improve the classification
During the first step. three key variables are analyzed: the early diastolic speed of the mitral ring (e ‘), the ratio between the speed of the early mitral flow and the estimated systolic pulmonary pressure.
If these data agree, a direct conclusion is established.
In the event of discrepancy. missing data, the second step includes additional parameters: the deformation of the left atrium reserve, the maximum indexed indexed atrial volume, the isovolometric relaxation time and the pulmonary venous flow. The presence of an abnormal value at this second step is enough to consider the filling pressure as high
new algorithm improves estimate left Standing results on the reduction of indefinite cases
One of the most significant results was that only 2 patients were classified as indeterminate with the new approach. against 38 patients with the application of the 2016 recommendations.
This statistically significant reduction in diagnostic uncertainty has practical implications. because it makes it possible to guide the therapeutic strategy more reliable.
High diagnostic precision confirmed in relation to cardiac catheterization
The performance of the algorithm has shown a sensitivity. a specificity of 86 %, with an overall precision of 86 %. These figures are greater than those obtained with previous recommendations. both for all patients and in those with a preserved ejection fraction (≥ 50 %).
The precision was similar in subjects with a reduced ejection fraction. This homogeneous performance confirms the robustness of algorithm in different clinical profiles.
Incremental value compared to natriuretic biomarkers
In a new algorithm improves estimate left subgroup of 663 patients with natriuretic peptide data. the algorithm has brought an incremental value in diagnostic discrimination. The net improvement in the reclassification was 1.1 while integrated discrimination increased by 0.3, both highly significantly significant results.
These observations support the idea that advanced echocardiography can provide additional information relevant to plasma biomarkers in the diagnosis. of cardiac dyspnea.
Clinical implications. future perspectives
The systematic application of the proposed algorithm makes it possible to reduce the proportion of cases with indefinite filling pressure, improve precision compared to the invasive standard and to offer an effective non -invasive alternative in contexts where cardiac catheterization is not always accessible or indicated. This approach also contributes to optimizing the differential diagnosis of dyspnea, one of the most common manifestations in cardiological practice.
However, the authors list some limits to their work. The study did not evaluate the role of diastolic effort new algorithm improves estimate left tests, recommended for symptomatic patients with diastolic grade dysfunction 1. The majority of patients also underwent cardiac catheterization to assess dyspnea. manage heart failure, which suggests that this sample had a higher probability of having a high LVFP. Researchers have noted that precision could be less when applied to populations where the prevalence of cardiovascular disease is lower.
However. they conclude that this new algorithm significantly improves the estimate of the LVFP and can be integrated as a routine tool in the echocardiographic assessment of patients suspected of heart failure, offering reinforced diagnostic clarity and facilitating therapeutic decisions based on objective and reproducible criteria.
Interest links:
One of the investigators said they are co-inventor of a method of analyzing myocardial segmental work and estimation of blood pressure in the heart, and having received fees from Ge Healthcare speaker.
Translated new algorithm improves estimate left and adapted article Of the interactive world network Medscape.
Follow Medscape in French on Bluesky , Facebook , Instagram , Linkedin , Youtube .
Register for Medscape Newsletters: Select your choices
Further reading: The code names of the PS6, the portable PS and the next generation of APU Xbox would have been confirmed – “We saw it before NASA”: amateur astronomers reveal this giant gaseous planet, a discovery that ridicules the pros of the spatial – “A huge scientific discovery”: a bone of one meter of a new kind of dinosaur spotted in France – The stapler who damaged the Switch 2 at GameStop auction – The two -step explosion of a Type IA supernova highlighted.
