Left Ventricular Filling Pressure Using E/E' Ratio as A Useful Marker for Predicting Periprocedural Myocardial Injury Following Percutaneous Coronary Intervention in Diabetic Patients

Objectives: Previous studies have demonstrated the role of E/E' ratio as a noninvasive predictor of elevated LV filling pressure that happen after PCI if myocardial injury happened. our aim was to evaluate whether elevated E/E' ratio would be a useful marker in predicting periprocedural myocardial injury and its adverse outcome following PCI.

Methods: 60 adult diabetic patients with troponin negative CAD underwent PCI for one or more of the major coronary arteries.All patients were subjected to full detailed echocardiography including e/e' ratio before and after PCI. The patients were subdivided and compared on the basis of troponin value after the PCI procedure: (positive group) and (negative group)., E/E' ratio was used as a measure for left ventricular filling pressure and compared with troponin increase as a measure for periprocedural myocardial injury.

Results: 24 patients were found to have increased troponin after PCI significantly with presence of PCI complications and increased number of DES. Septal E' was improved after successful PCI procedure and showed significant increase in its velocity. E/E' ratio was found to be increased in troponin positive group as a result of increased LV filling pressure that happened after periprocedural myocardial injury. Average e/e' ratio can differentiate between patient's troponin negative and positive value (predict periprocedural myocardial injury) with very high level of statistical clinical significance 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 &

Recommendations: Despite its limitations, 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 for its reliability.