Abstract 10342: Noninvasive Estimation of Pulmonary Capillary Wedge Pressure Using the Novel Kinetics-Tracking Index Assessed by Combination of Left Atrial Volume and Function
Background: We have recently developed a novel index to estimate pulmonary capillary wedge pressure (ePCWP) using a combined assessment of left atrial (LA) volume (LAV) and LA emptying function (EF) by speckle tracking echocardiography and named it Kinetics-Tracking (KT) index: log10 (LAEF/ LAV index). The aim of this study was to examine the usefulness of the KT index in a larger population with preserved or reduced left ventricular ejection fraction (LVEF) by comparison of ePCWP estimated by KT index with PCWP measured by cardiac catheterization.
Methods: We examined phasic LAV and EF from time-LA volume curve during sinus rhythm just before cardiac catheterization in the validation study (n=50, age 67±10) and obtained the formula to estimate ePCWP using LAV, EF, E/e’ and KT index. ePCWP was most accurately estimated by KTam index: 10.7 - 12.4 x log10 LA active EF/minimum LAV index. In the testing study, the ePCWP estimated by LAV, EF, E/e’ and KTam index were compared with PCWP measured by cardiac catheterization in 106 patients (age 68±10, 60 patients with LVEF≥55%). Moreover, ePCWP estimated by 4 combinations of maximum or minimum LAV and LA total or active EF including KTam index was compared with PCWP.
Results: The maximum and minimum LAV were correlated with PCWP (r=0.67 and 0.76, respectively, p<0.05). LA total, passive and active EF were inversely correlated with PCWP (r=-0.73, r=-0.30 and r=-0.82, respectively, p<0.05), whereas, there was a weak correlation between E/e’ and PCWP (r=0.46, p<0.05). In contrast, ePCWP by KTam index had the strongest correlation with PCWP (r=0.91, p<0.01) among combinations of LAV and LAEF. Using KTam index of 18 as a cutoff value, the sensitivity and specificity to predict elevated PCWP>15mmHg were 100 and 85%, respectively (AUC=0.97). In both patients with reduced or preserved LVEF, ePCWP by KT index had a strong relation with PCWP (r=0.90, r=0.90, p<0.01, respectively). In a multivariate regression analysis, only KTam index was an independent predictor of PCWP.
Conclusions: The KT index is a novel and more accurate predictor of PCWP than LA function, volume solely or E/e’. The KT index has an incremental value for noninvasive diagnosis of heart failure in a routine clinical practice.
- © 2013 by American Heart Association, Inc.