Abstract
BackgroundWe aimed to identify the clinical utility of a simple echocardiographic approach for estimating the pulmonary capillary wedge pressure (PCWP) on the basis of the combined assessment of mitral inflow and tissue Doppler mitral annular velocities.MethodsWe retrospectively enrolled 165 patients who underwent both echocardiographic examination and right heart catheterization, and determined the diagnostic accuracy of echocardiography-derived parameters for estimating PCWP >18 mmHg.ResultsEighty-three patients had preserved left ventricular (LV) ejection fraction ≥50% (the PEF group) and 82 patients had reduced LVEF <50% (the REF group). The PEF group had higher peak early mitral annular velocity (E′) compared with the REF group. Eight patients in the PEF group but none in the REF group had normal LV diastolic function, represented as E′ >8 cm/s, and all of these patients had normal inflow pattern. The mean PCWP had the strongest correlation with the ratio of the peak early mitral inflow velocity (E) to the peak late diastolic mitral inflow velocity during atrial contraction (E/A) in both groups, followed by the left atrial diameter and E/E′ in both patient groups. Receiver operating characteristic (ROC) analysis demonstrated that the combination of abnormal E′ ≤8 and elevated E/A had high diagnostic accuracy compared with E/E′ in both patient groups with different cutoff values of E/A (1.81 in the PEF group and 1.16 in the REF group) for predicting mean PCWP >18 mmHg.ConclusionAfter excluding patients with normal diastolic function using E′, conventional E/A is a reliable marker for predicting high PCWP and is superior to E/E′.
Highlights
Measured pulmonary capillary wedge pressure (PCWP) has been widely used as a surrogate for left ventricular (LV) filling pressure and is directly associated with functional capacity and prognosis in patients with heart failure [1,2,3]
Background We aimed to identify the clinical utility of a simple echocardiographic approach for estimating the pulmonary capillary wedge pressure (PCWP) on the basis of the combined assessment of mitral inflow and tissue Doppler mitral annular velocities
After excluding patients with normal diastolic function using E0, conventional E and A velocities (E/A) is a reliable marker for predicting high PCWP and is superior to E/E0
Summary
Measured pulmonary capillary wedge pressure (PCWP) has been widely used as a surrogate for left ventricular (LV) filling pressure and is directly associated with functional capacity and prognosis in patients with heart failure [1,2,3]. The mitral inflow patterns, traditional, and simple Doppler indices have U-shaped relations to LV filling pressure, they can be used for the estimation of the PCWP with reasonable accuracy after discriminating patients with diastolic dysfunction from those having normal diastolic function and, thereby, normal inflow pattern. A simple combination of E0 and mitral inflow pattern would provide a more precise estimation of high PCWP in patients having both reduced and preserved LVEF. Our objective was to identify the potential reliability of a simple echocardiographic approach for predicting high LV filling pressure by the combined assessment of mitral inflow and tissue Doppler mitral annular velocities in patients with reduced and preserved LVEF with heterogeneous etiologies of heart disease. We aimed to identify the clinical utility of a simple echocardiographic approach for estimating the pulmonary capillary wedge pressure (PCWP) on the basis of the combined assessment of mitral inflow and tissue Doppler mitral annular velocities
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