Left-ventricular filling pressure estimation in HFpEF, is echocardiography reliable?

Abstract

Echocardiography is frequently used for the left-ventricular filling pressure (LVFP) measurement in heart failure with preserved ejection fraction (HFpEF), however invasive measurements remain the gold standard. We aimed to evaluate the diagnostic value of different echocardiographic parameters taken individually and the 2016 echocardiographic grading algorithms for predicting LVFP. Invasive hemodynamic and echocardiographic measurements were simultaneously performed in 90 patients with heart failure New York Heart Association class ≥ II, left-ventricular ejection fraction (LVEF) ≥ 50%, enrolled prospectively in our center for pulmonary hypertension evaluation. Mean age of the study patients was 70 ± 8 years, 64% were female, mean LVEF was 63 ± 5%, and 39% had atrial fibrillation at the time of measurement. Mean PAWP and mPAP were 19 ± 6 and 37 ± 11 mmHg, respectively. Taken individually, PAWP was correlated with E/E’ mean ( r = 0.23; P = 0.04), E pick ( r = 0.36; P = 0.0009), left-ventricular mass ( r = 0.27; P = 0.008), tricuspid regurgitation (tr) jet velocity ( r = 0.27, P = 0.02) and left atrial volume (LAVi) ( r = 0.24; P = 0.03). Correlation coefficients were higher in patients without atrial fibrillation. The area under the curve for classifying elevated LVFP by ASE/EACVI algorithm taking into account E/e’ mean, TR velocity and LAVi algorithm was 0.72. Echocardiographic parameters, including the E/e’ ratio, have a poor to moderate predictive value for the estimation of invasively acquired PAWP especially in patient with atrial fibrillation. Using the 2016 recommendations ASE/EACVI algorithm to evaluate LVFP has to be used with caution.