Abstract 14896: Does Echocardiography/Doppler Reliably Predict Elevated LVEDP?
Introduction: Heart failure with preserved ejection fraction is a common cause of group 2 pulmonary hypertension (PH). The utility of echocardiography (echo)/ Doppler for identification of elevated left ventricular end-diastolic pressure (LVEDP) specifically among patients with PH is not well defined.
Methods: 161 patients referred to Pulmonary Hypertension Clinic were retrospectively studied. Included patients underwent echo/Doppler and had catheter measurement of LVEDP or pulmonary capillary wedge pressure within a 3-month period, had normal sinus rhythm at the time of the TTE, and had unchanged diuretic and PH regimens during the examination interval. The ability of echo to predict elevated LVEDP (> 15 mm Hg) based on American Society of Echocardiography (ASE) / European Association of Echocardiography (EAE) guidelines was evaluated, and a new model was developed for better prediction of elevated LVEDP with echo data using univariate linear regression and multi-variable logistic regression; receiver operating characteristics were analyzed.
Results: Of 161 patients, 81 (51%) had LVEDP > 15 mm Hg on invasive testing; mean PAP was 37.8 ± 14.3 mmHg and PVR was 4.6 ±3.8 WU. Doppler E/A, E/e’ (septal, lateral, average), e’/a’ (lateral and average), LA volume, and LA diameter had significant correlation with LVEDP (p values < 0.05). There was poor test performance of both the ASE/EAE model and the experimental model (area under the ROC 0.7, p < 0.001). Only echo/Doppler grade III had a mean LVEDP significantly different from other grades (p value < 0.05).
Conclusions: Numerous echo/Doppler measurements correlate with elevated LV filling pressure. However, both the ASE/EAE model and our experimental model had poor test performance that did not permit confident identification of patients with elevated LVEDP. Assessment using echo/Doppler is not adequate to either reliably include or exclude patients with elevated LVEDP as a cause of severe PH.
Author Disclosures: D.M. Cameron: None. D. Bach: None. V. McLaughlin: None. M. Rubenfire: None. S. Visovatti: None.
- © 2015 by American Heart Association, Inc.