Diastolic Filling Parameters Derived from Myocardial Perfusion Imaging Can Predict Left Ventricular End-Diastolic Pressure at Subsequent Cardiac Catheterization

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FIGURE 1.
Left ventricular diastolic filling curves derived from 4D-MSPECT. (A) Curve with normal diastolic filling parameters. (B) Curve with abnormal diastolic filling parameters. LVEDPs determined at subsequent cardiac catheterization are shown. bpm = beats per minute; EF = ejection fraction; ESV = end-systolic volume; HR = heart rate; LV = left ventricular; MFR3 = filling rate during first third of diastole; PER = peak emptying rate; TPER = time to peak emptying rate; vol = volume.
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FIGURE 2.
Correlations between 4D-MSPECT diastolic parameters and LVEDP.
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FIGURE 3.
Correlation between LVEDP and resting ²⁰¹Tl LHR.
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FIGURE 4.
ROC curve analysis for ability of PFR (A), TPFR (B), and 1/3FR (C) to detect LVEDPs of ≥18 mm Hg or <18 mm Hg.

TABLE 1

Characteristics of Study Population

Characteristic	Mean ± SD or mean (%)
Age (y)	58 ± 11
Men^*	30 (58)
CAD^*	38 (73)
Diabetes mellitus^*	15 (29)
Hypertension^*	42 (81)
Interval between MPI and cardiac catheterization (d)	8 ± 3.50
Heart rate (beats/min)	72 ± 12
Ejection fraction (%)	54.2 ± 4.66
Mean LVEDP (mm Hg)	15.07 ± 5.30
Resting ²⁰¹Tl LHR	0.57 ± 0.10
PFR (EDV/s)	2.63 ± 0.68
TPFR (ms)	175.77 ± 49.99
1/3FR (EDV/s)	1.43 ± 0.43

TABLE 2

ROC Curve Analysis, Sensitivity, Specificity, PPV, and NPV

Diastolic filling variable(s)	AUC	95% Confidence interval for AUC	Optimal cutoff value(s) for detecting LVEDPs of ≥18 mm Hg	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
PFR	0.83	0.72–0.95	≤2.57 EDV/s	82	80	67	90
TPFR	0.75	0.62–0.89	≥161 ms	88	63	54	92
1/3FR	0.80	0.68–0.93	≤1.52 EDV/s	82	74	61	90
PFR + 1/3FR			≤2.57 EDV/s + ≤1.52 EDV/s	67	94	86	84