OBJECTIVES The aim of this study was to investigate whether cluster analysis of left atrial and left ventricular (LV)
mechanical deformation parameters provide sufficient information for Doppler-independent assessment of LV diastolic
function.
BACKGROUND Medical imaging produces substantial phenotyping data, and superior computational analyses could
allow automated classification of repetitive patterns into patient groups with similar behavior.
METHODS The authors performed a cluster analysis and developed a model of LV diastolic function from an initial
exploratory cohort of 130 patients that was subsequently tested in a prospective cohort of 44 patients undergoing
cardiac catheterization. Patients in both study groups had standard echocardiographic examination with Doppler-derived
assessment of diastolic function. Both the left ventricle and the left atrium were tracked simultaneously using
speckle-tracking echocardiography (STE) for measuring simultaneous changes in left atrial and ventricular volumes,
volume rates, longitudinal strains, and strain rates. Patients in the validation group also underwent invasive
measurements of pulmonary capillary wedge pressure and LV end diastolic pressure immediately after echocardiography.
The similarity between STE and conventional 2-dimensional and Doppler methods of diastolic function was
investigated in both the exploratory and validation cohorts.
RESULTS STE demonstrated strong correlations with the conventional indices and independently clustered the patients
into 3 groups with conventional measurements verifying increasing severity of diastolic dysfunction and LV filling
pressures. A multivariable linear regression model also allowed estimation of E/e0 and pulmonary capillary
wedge pressure by STE in the validation cohort.
CONCLUSIONS Tracking deformation of the left-sided cardiac chambers from routine cardiac ultrasound images provides
accurate information for Doppler-independent phenotypic characterization of LV diastolic function and noninvasive assessment
of LV filling pressures.
