CORRELATION OF COLOUR M--MODE PROPAGATION VELOCITY WITH LEFT VENTRICULAR DIASTOLIC FUNCTION PARAMETERS IN ACUTE HEART FAILURE PATIENT WITH PRESERVED EJECTION FRACTION
Authors: Andrianto * , Pratama Ivan Satria , Subagjo Agus , Fatimah Fahrun Nisa’i , Ramadhan Muhammad , Nugraha Ricardo Adrian 
Published: June 2023

BACKGROUND: Colour M–mode propagation velocity (Vp) is an
echocardiographic parameter that represents relaxation of the left
ventricular (LV) and the ratio of peak E-wave velocity and flow
propagation velocity (E/Vp) can be used to measure pulmonary capillary
wedge pressure (PCWP) estimation which is almost equivalent to
invasively measured PCWP. The correlation between propagation velocity
(Vp) with standard left ventricular diastolic function parameters and
E/Vp with PCWP in patients with acute heart failure with preserved
ejection fraction (HFpEF) has not been widely studied. This study aimed
to determine the correlation of Vp in the assessment of left ventricular
diastolic function in acute heart failure patients with HFpEF.
METHODS: This research is an observational analytical study
using a cross–sectional study design conducted from April to June 2022.
The subjects of this study were patients diagnosed with acute HFpEF and
treated at Dr. Soetomo General Academic Hospital, Surabaya. Patients
with heart rhythm disturbances, moderate to severe valvular heart
disease, and congenital heart defects were excluded from this study.
Patients were measured for diastolic function including mitral valve
early mitral inflow velocity (MV E Velocity), mitral peak velocity of
early filling (E’) (E’ Septal and E’ Lateral), left atrial volume index
(LAVI), The maximal tricuspid regurgitation velocity (TR V Max), Vp, the
ratio of early diastolic mitral inflow velocity to early diastolic
mitral annulus velocity (E/E’), the ratio between early and late
ventricular filling velocity (E/A) and E/Vp Ratio. N-terminal-pro
hormone B-type natriuretic peptide (NT–ProBNP) examination was also
performed on study subjects as an additional diagnosis of acute heart
failure. RESULTS: There were 33 patients who met the inclusion
and exclusion criteria and were included in our study. There were 26
patients (78.8%) with grade I diastolic dysfunction, 4 patients
(12.1%) with grade II diastolic dysfunction, and 3 patients (9.1%)
with grade III diastolic dysfunction. There is a strong positive
correlation between Vp with parameters E’ Septal (p = < 0.001;
r = 0.636) and E’ Lateral (p = < 0.001; r = 0.650). Vp is
negatively correlated with the ratio E/E’ (p = 0.029; r = –0.37). The
PCWP estimate with E/Vp ratio had a strong correlation with the NT–Pro
BNP value > 300 pg/ml in acute HFpEF patients (p =
< 0.001; r = 0.726) compared to the PCWP estimate with E/E’ (p
= < 0.001; r = 0.549). There is no correlation between Vp
value and degree of diastolic dysfunction in patients with acute HFpEF.
CONCLUSION: Vp has a strong correlation in the assessment of
left ventricular diastolic function parameters with acute HFpEF. PCWP
estimation using E/Vp ratio has a strong correlation with NT–ProBNP
> 300 pg/ml. Measurement of Vp value and E/Vp ratio can be
used to assess diastolic function and estimate PCWP in patients with
acute HFpEF.