ORIGINAL PAPER Global endocardial area change rate for the assessment of left ventricular relaxation and filling pressure: using 3-dimensional speckle-tracking study Kazuhiro Tatsumi • Hidekazu Tanaka • Kensuke Matsumoto • Takuma Sawa • Tatsuya Miyoshi • Junichi Imanishi • Yoshiki Motoji • Yasuhide Mochizuki • Yuko Fukuda • Toshiro Shinke • Ken-ichi Hirata Received: 17 April 2014 / Accepted: 2 July 2014 / Published online: 15 July 2014 Ó Springer Science+Business Media Dordrecht 2014 Abstract Early diastolic mitral inflow and annulus velocities ratio (E/e’) is the parameter used to estimate left ventricular (LV) filling pressure, but their use for patients with reduced ejection fraction (EF) ( \ 50 %) is controver- sial. LV endocardial area change rate with 3-dimensional (3-D) speckle-tracking can be used to evaluate the entire LV diastolic function, we tested the hypothesis that the early diastolic area change rate (E-ACR) represents LV relaxation, and E and E-ACR ratio (E/E-ACR) can accu- rately predict LV filling pressure in patients with reduced and preserved EF (C50 %). We studied 125 patients with EF of 40 ± 17 %. E-ACR of all patients was measured using the global area change rate, and LV relaxation time constant (s, n = 53) and pulmonary capillary wedge pressure (PCWP, n = 125) were measured by cardiac catheterization. E-ACR significantly correlated with s (r =-0.60, p \ 0.001). In the retrospective group (n = 101), E/E-ACR correlated with PCWP for patients with reduced EF as well as those with preserved EF (n = 79 and 22, r = 0.62 and 0.81, both p \ 0.001). In overall patients, E/E-ACR C94 cm was a better predictor of elevated mean PCWP ( [ 12 mmHg) (sensitivity: 69 %, specificity: 87 %, areas under the curves = 0.82; p \ 0.001) and was a more accurate predictor than E/e’ (p = 0.001) for the retrospective group. For the validation group (n = 24), E/E-ACR C94 cm was similarly predic- tive for elevated mean PCWP (sensitivity: 60 %, specificity: 100 %, positive predictive value: 100 %, neg- ative predictive value: 78 %). In conclusions, global E-ACR by 3-D speckle-tracking proved to be dependent on LV relaxation. Moreover, E/E-ACR was found to be a powerful predictor of LV filling pressure regardless of EF. Keywords Filling pressure Á Heart failure Á 3-dimensional speckle-tracking echocardiography Á Left ventricular relaxation Introduction Determination of increased left ventricular (LV) filling pressure is an important factor in the diagnosis of primary systolic and diastolic heart failure [1], and an important marker of poor prognosis [2]. An established non-invasive parameter for estimating LV filling pressure is the ratio of peak early diastolic trans-mitral flow velocity (E) to peak early diastolic mitral annular velocity (e’) derived from conventional pulsed-wave and tissue Doppler echocardi- ography. However, tissue Doppler imaging (TDI) has two inherent limitations which may have a negative impact on the accuracy of e’ measurements. TDI is angle-dependent and is affected by tethering of adjacent myocardium and whole heart translation. Moreover, the E/e’ ratio proved to be not so reliable for predicting LV filling pressure in decompensated patients with LV ejection fraction (EF) \ 30 % [3]. On the other hand, 2-dimensional (2-D) speckle-tracking echocardiography is angle-independent and is not affected by tethering or translation, and 2-D speckle-tracking diastolic strain rate parameters have been shown to be associated with LV relaxation and filling pressure [4–7]. However, 2-D speckle-tracking is limited to 2-D tomographic imaging planes, which may oversimplify K. Tatsumi Á H. Tanaka (&) Á K. Matsumoto Á T. Sawa Á T. Miyoshi Á J. Imanishi Á Y. Motoji Á Y. Mochizuki Á Y. Fukuda Á T. Shinke Á K. Hirata Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan e-mail: tanakah@med.kobe-u.ac.jp 123 Int J Cardiovasc Imaging (2014) 30:1473–1481 DOI 10.1007/s10554-014-0486-9