Abstract 12904: Usefulness of Novel Tissue Doppler Imaging Technique for Noninvasive and Reliable Estimation of Left-Sided Filling Pressure in Patients With Heart Failure
Backgrounds: Accurate noninvasive assessment of left ventricular filling pressure (pulmonary capillary wedge pressure, PCWP) is important in patients with heart failure (HF). Although several tissue Doppler imaging (TDI) techniques, such as the early diastolic transmitral flow velocity to mitral annular velocity ratio (E/Ea), have been reported previously, their reliability was questioned. Our experimental results suggested that right atrial pressure (RAP) corrected by tissue Doppler tricuspid/mitral annular peak systolic velocities (ST/SM) (RAPхST/SM) reliably predicts elevated PCWP. However, in our previous study, RAP was measured invasively, and we aimed to investigate the usefulness of this TDI technique with the diameter of inferior vena cava at inspiration (IVCD) as a noninvasive alternative to RAP by echocardiography for predicting elevated PCWP in HF patients.
Methods: Patients admitted with HF and scheduled for right heart catheterization (RHC) were prospectively enrolled. We measured RAP and PCWP in RHC, and ST/SM, E/Ea, and IVCD by echocardiography.
Results: A total of 138 patients were screened for this study. 40 patients with severe valvular heart disease and/or acute coronary syndrome were excluded. In 98 patients enrolled in this study, RAPхST/SM strongly correlated with PCWP (2-37 mmHg) (R2=0.64). RAP and IVCD were also tightly correlated (R2=0.57). A significantly stronger correlation was observed between IVCD corrected by ST/SM (IVCDхST/SM) and PCWP than between E/Ea and PCWP (R2=0.50 vs. 0.18, P<0.05). Receiver operating characteristics (ROC) curve analysis indicated that IVCDхST/SM >18 mm predicted PCWP>18 mmHg with 85% sensitivity and 76% specificity with area under the curve (AUC) of 0.86, which was significantly larger than that of E/Ea(AUC=0.72) (Figure, P<0.05).
Conclusions: The new TDI technique with IVCD measurement may offer an accurate noninvasive diagnostic method to assess elevated PCWP in HF patients.
Author Disclosures: D. Chinen: None. T. Nagai: None. K. Uemura: None. Y. Aikawa: None. T. Motokawa: None. Y. Sugano: None. Y. Asaumi: None. T. Ogo: None. H. Kanzaki: None. W. Shimizu: None. K. Kusano: None. M. Ishihara: None. T. Anzai: None. H. Ogawa: None. S. Yasuda: None.
- © 2014 by American Heart Association, Inc.