Left ventricular filling pressure using E/E' ratio as a useful marker for predicting periprocedural myocardial injury following percutaneous coronary intervention in diabetic patients

Background and objectives

The identification of patients with coronary artery disease at greater risk of developing periprocedural myocardial injury (PMI) would allow targeted novel therapies to reduce its burden. The availability of sensitive serum biomarkers of myocardial injury has enabled the quantification of previously undetectable PMI.

Echocardiographic indices of high left ventricular (LV) filling pressures are associated with adverse remodeling, an increased incidence of heart failure, and worse survival. The ratio of early trans mitral flow velocity to early diastolic mitral annulus velocity (E/E') has recently been shown to be the most accurate noninvasive predictor of elevated LV filling pressure. So we aimed to evaluate whether elevated E/E' ratio would be a useful marker in predicting periprocedural myocardial injury and its adverse outcome following Percutaneous coronary intervention (PCI) in diabetic patients.

Methods

We prospectively studied 60 adult diabetic patients admitted to Catheterization units in the year 2017 to 2019 with coronary artery disease (but negative troponin) and underwent PCI for one or more of the major coronary arteries. The patients were subdivided and compared on the basis of troponin value after the PCI procedure into : (group A = patients with CAD and negative troponin) and (group B = patients with CAD and positive troponin). E/E' ratio was used as a measure LV filling pressure and compared with troponin increase as a measure for PMI.

Results

24 patients were found to have increased troponin after PCI. The presence of PCI complications and increased use of drug eluting stents (DES) increased the risk of PMI. Septal E' was improved after successful PCI procedure and showed significant increase in its velocity. E/E' ratio was found to be increased in group B as a result of increased LV filling pressure that happened after periprocedural myocardial injury. Average E/E' ratio can help to differentiate between both groups (predict PMI with very high level of statistical clinical significance (p. value <0.0001) with optimal value > 10.7, with sensitivity and specificity (79.17% and 87.11%) respectively. Positive and negative predictive value for average E/E' ratio was (79.2 and 86.1) respectively.

Conclusions

Despite its limitations, the above data support the hypothesis that E/E' ratio can provide useful information on the LV filling pressure in cardiac patients and can be used as a reliable biomarker for early prediction of periprocedural myocardial injury in diabetic ischemic patients. But, further studies on a larger number of patients are needed to confirm its reliability.