Abstract 12421: Impact of Acute Hemodynamic Changes on Pulmonary Capillary Wedge Pressure Estimated by the Novel Kinetics-Tracking Index With 2- and 3-Dimensional Speckle Tracking Echocardiography
Background: We reported that pulmonary capillary wedge pressure (ePCWP) could be accurately estimated by a novel kinetics-tracking (KT) index that included both atrial (LA) volume (LAV) and emptying function (EF) [KT index = log (LAEF / LAV index)]. Whether the KT index can accurately predict PCWP during acute hemodynamic changes is unknown. We sought to test the feasibility of KT index for the evaluation of acute hemodynamic changes caused by fluid removal through dialysis as well as volume overload by leg elevation.
Methods: To examine the response of ePCWP to acute hemodynamic changes, we measured phasic LAV and LAEF by 3-dimensional speckle tracking echocardiography (3D-STE) before and after dialysis in 60 patients (age 61±13, 36 men) and by 2D-STE before and after leg elevation during catheterization in 10 patients (age 70±5, 6 men). Plasma ANP and body weight (BW) were also measured before and after dialysis. ePCWP was calculated as 10.7 - 12.4 x log (active LAEF / minimum LAV index). LA active EF was defined as (pre-atrial contraction LAV - minimum LAV) / pre-atrial contraction LAV.
Results: Maximum and minimum LAV decreased and LA active EF increased after dialysis (73±18 vs. 50±14, 38±13 vs. 28±9ml/m2 and 33±8 vs. 39±6%, respectively, p≤0.01). ePCWP decreased from 8.8±2.7 to 6.3±2.0 mmHg (p≤0.01), and this was associated with a reduction of BW (from 58.3±11.9 to 56±11.4kg, p≤0.05) and ANP (from 152±88 to 45±22pg/ml, p≤0.05) during dialysis. The % change in ePCWP during dialysis was significantly associated with the % changes in BW and ANP (r=0.71 and r=0.54, respectively, p≤0.05). With leg elevation during catheterization, ePCWP and PCWP significantly increased by 2.5±0.7 and 2.0±0.3 mmHg, and this was associated with increased maximum LAV from 68±18 to 83±20 ml/m2. ePCWP had a good correlation with PCWP before and after leg elevation (r=0.92 and r=0.89, respectively).
Conclusions: ePCWP obtained by the KT index was reduced after dialysis and corresponded with the reduction in BW and ANP. ePCWP had a good correlation with PCWP before and after leg elevation. These results suggest that ePCWP could respond to acute hemodynamic changes caused by water removal or volume increase and may be useful in the diagnosis of acute heart failure.
- © 2013 by American Heart Association, Inc.