Elevated right atrial pressure by echocardiography significantly increases the likelihood of concomitant elevated pulmonary capillary wedge pressure in heart transplant recipients

Abstract

Background and aim: Diastolic dysfunction is a recognized complication in heart transplant recipients that limits exercise capacity and is a risk factor for mortality. In the present study we investigated the ability of echocardiography to identify patients with increased Pulmonary Capillary Wedge Pressure (PCWP>15 mmHg). Methods: Patients with echocardiography and right heart catheterization within 24 hours were included (n=97, 110 investigations). Echocardiographic estimation of PCWP was performed using mitral [E/A, Deceleration Time (DT), Isovolumic Relaxation Time (IVRT)], pulmonary vein (S/D) and tissue Doppler (E/E') variables. The estimation of Right Atrial Pressure (RAP) was in categories (0, 5, 10, 15, 20 mmHg) and based on the effect of respiration or sniffing on the maximum and minimum Inferior Vena Cava (IVC) diameters. The caval index was calculated [(IVCmax-IVCmin)/IVCmax x 100]. Cut-off values were generated to determine increased PCWP using receiver-operator characteristic curve analysis. Results: The mean±SD age was 36±13 years and 78% were male. Rejection ≥ ISHLT grade 2R was found in 6.3% and elevated PCWP in 39%. The linear relation between catheter PCWP and E/A, S/D, DT, IVRT and lateral wall E/E' was weak with correlation coefficient/p-value 0.52/ 8 mmHg) was observed in 91% of patients with elevated PCWP and 15% of those without. Best diagnostic performance was found using variables related to RAP (Table). The presence of elevated RAP by echocardiography increased the likelihood of elevated PCWP 9.1 fold, and normal RAP reduced the likelihood 5 fold. View this table: Table 1. Diagnostic performance Conclusions: There is a strong concordance between filling pressure in the right and left ventricle in heart transplant recipients. Elevated RAP by echocardiography significantly increases the likelihood of concomitant elevated PCWP.