Abstract 10918: Relation Between Natriuretic Peptide and Pulmonary Capillary Wedge Pressure Estimated by the Combination of Left Atrial Volume and Function With Speckle Tracking Echocardiography
Background: B-type natriuretic peptide (BNP) concentration in patients with cardiovascular disease is associated with increased left ventricular (LV) filling pressure. Atrial natriuretic peptide (ANP) is a useful marker to estimate LA pressure since ANP depends on pressure overload in the left atrium (LA). Thus, we compared BNP and ANP with the novel echocardiographic parameter that was named KT index and assessed by the combination of LA volume (LAV) and function to accurately estimate pulmonary capillary wedge pressure (ePCWP) and sought to examine the usefulness of the KT index.
Methods: Phasic LAV and emptying function (EF) were measured by a speckle tracking echocardiography (STE) in 89 patients with various cardiac diseases excluding mitral valve stenosis (age: 65±10, 50 men). We estimated ePCWP as 10.7 - 12.4 x log KT index: KT index = active LAEF / minimum LAV index as we previously reported. The ePCWP was compared with BNP and ANP. Moreover, PCWP was measured by cardiac catheterization in 33 patients and compared with ePCWP by STE and BNP measured at the same time. LV mass index, LV ejection fraction, E/e’, LA strain, volume and function were also compared with BNP.
Results: The ePCWP correlated strongly with PCWP measured by cardiac catheterization (r=0.88). The PCWP had a moderate linear correlation with ln BNP (PCWP=2.9 x ln BNP + 2.1, r=0.65, p<0.01). The ePCWP estimated by STE also had a linear correlation with ln BNP and ln ANP (ePCWP = 2.9 x ln BNP + 0.8, r=0.76, p<0.01 and ePCWP = 2.4 x ln ANP - 2.4, r=0.70, p<0.01). In contrast, the LV mass index had no correlation with BNP. LV ejection fraction, E/e’, minimum LAV and LA active EF had a significant but weak or moderate correlation with ln BNP (r=-0.29, r=0.59, r=0.68 and r= 0.54, p<0.05, respectively). In multivariate regression analysis, only ePCWP is independently associated with ln BNP. Using 14 of ePCWP as cutoff, the sensitivity and specificity for predicting BNP>100 was 93 and 64% (AUC=0.81).
Conclusions: PCWP could be estimated by a novel echocardiographic parameter using the combined assessment of LAV and LAEF by STE. The ePCWP had an excellent correlation with BNP and ANP, suggesting that the ePCWP by the novel KT index has an incremental value in the diagnosis and treatment of heart failure.
- © 2013 by American Heart Association, Inc.