Abstract 10320: Pulmonary Capillary Wedge Pressure Estimated by Kinetics-Tracking Index Obtained From the Combined Assessment of Left Atrial Volume and Function in Patients With Atrial Fibrillation
Background: Evaluation of diastolic abnormalities and noninvasive estimation of pulmonary capillary wedge pressure (PCWP) in atrial fibrillation (AF) remains clinically challenging. We have recently developed a novel and accurate index to estimate PCWP using left atrial (LA) emptying function (EF) and volume (LAV) in sinus rhythm and named it kinetics-tracking (KT) index: log LAEF / LAV index. However, usefulness of the KT index in AF rhythm is unknown. Thus, we sought to examine the feasibility and the accuracy of KT index in patients with AF by comparing ePCWP estimated by KT index with PCWP measured by cardiac catheterization.
Methods: Maximum (max) and minimum (min) LAV and LAEF in consecutive 43 patients with AF (age 67±8, 38 men) were measured just before cardiac catheterization by speckle tracking echocardiography (STE) that can provide the time-LA volume curve automatically. Patients with severe mitral valve disease were excluded. We estimated ePCWP using KT index and compared it with PCWP measured by cardiac catheterization. LAEF was defined as (max LAV - min LAV) / max LAV x 100%. E/e’ and E/A were also measured. Average of three cardiac cycles was analyzed.
Results: Max and min LAV measured by STE was directly associated with PCWP measured by cardiac catheterization (r=0.48 and r=0.59, respectively, p<0.05). LAEF was inversely associated with PCWP (r=-0.68, p<0.01). Log LAEF / min LAV index (KT index) was linearly associated with PCWP (r=-0.76, p<0.01). The ePCWP estimated by KT index had a good correlation with PCWP by catheterization (ePCWP=10.7 - 12.4 x log KT index, r=0.79, p<0.001). E/e’ was weakly associated with PCWP (r=0.48, p<0.05). In multivariate analysis, only KT index was independently associated with PCWP measured by catheterization. Using 16 of KT index as an optimal cutoff, the sensitivity and specificity for elevated PCWP>15mmHg were 90% and 77% (AUC=0.88).
Conclusion: The ePCWP was easily estimated by the KT index that is obtained from the combination of LAEF and LAV using STE in patients with AF. This pilot study demonstrated that the combined assessment of LA volume and LA function is a novel and more powerful predictor for PCWP in AF rhythm as well as sinus rhythm than any other echocardiographic parameter.
- © 2013 by American Heart Association, Inc.