Echocardiographic estimation of pulmonary artery wedge pressure - invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading.
diastolic dysfunction
echocardiography
heart failure
pulmonary capillary wedge pressure
Journal
European heart journal. Cardiovascular Imaging
ISSN: 2047-2412
Titre abrégé: Eur Heart J Cardiovasc Imaging
Pays: England
ID NLM: 101573788
Informations de publication
Date de publication:
09 Nov 2023
09 Nov 2023
Historique:
received:
13
09
2023
revised:
01
11
2023
accepted:
04
11
2023
medline:
11
11
2023
pubmed:
11
11
2023
entrez:
10
11
2023
Statut:
aheadofprint
Résumé
Grading of diastolic function can be useful, but indeterminate classifications are common. We aimed to invasively derive and validate a quantitative echocardiographic estimation of pulmonary artery wedge pressure (PAWP), and to compare its prognostic performance to diastolic dysfunction grading. Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analyzed in the National Echocardiography Database of Australia (NEDA). In patients who had undergone both RHC and echocardiography within two hours (n=90), ePAWP was derived using left atrial volume index, mitral peak early velocity (E), and pulmonary vein systolic velocity (S). In a separate external validation cohort (n=53, simultaneous echocardiography and RHC), ePAWP showed good agreement with invasive PAWP (mean±SD difference 0.5±5.0 mmHg) and good diagnostic accuracy for estimating PAWP>15mmHg (area under the curve [95% confidence interval] 0.94 [0.88-1.00]). Among patients in NEDA (n=38,856, median [interquartile range] follow-up 4.8 [2.3-8.0] years, 2,756 cardiovascular deaths), ePAWP was associated with cardiovascular death even after adjustment for age, sex, and diastolic dysfunction grading (hazard ratio (HR) 1.08 [1.07-1.09] per mmHg) and provided incremental prognostic information to diastolic dysfunction grading (improved C-statistic from 0.65 to 0.68, p<0.001). Increased ePAWP was associated with worse prognosis across all grades of diastolic function (HR normal: 1.07 [1.06-1.09]; indeterminate: 1.08 [1.07-1.09]; abnormal: 1.08 [1.07-1.09], p<0.001 for all). Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction grading.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Grading of diastolic function can be useful, but indeterminate classifications are common.
OBJECTIVES
OBJECTIVE
We aimed to invasively derive and validate a quantitative echocardiographic estimation of pulmonary artery wedge pressure (PAWP), and to compare its prognostic performance to diastolic dysfunction grading.
METHODS
METHODS
Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analyzed in the National Echocardiography Database of Australia (NEDA).
RESULTS
RESULTS
In patients who had undergone both RHC and echocardiography within two hours (n=90), ePAWP was derived using left atrial volume index, mitral peak early velocity (E), and pulmonary vein systolic velocity (S). In a separate external validation cohort (n=53, simultaneous echocardiography and RHC), ePAWP showed good agreement with invasive PAWP (mean±SD difference 0.5±5.0 mmHg) and good diagnostic accuracy for estimating PAWP>15mmHg (area under the curve [95% confidence interval] 0.94 [0.88-1.00]). Among patients in NEDA (n=38,856, median [interquartile range] follow-up 4.8 [2.3-8.0] years, 2,756 cardiovascular deaths), ePAWP was associated with cardiovascular death even after adjustment for age, sex, and diastolic dysfunction grading (hazard ratio (HR) 1.08 [1.07-1.09] per mmHg) and provided incremental prognostic information to diastolic dysfunction grading (improved C-statistic from 0.65 to 0.68, p<0.001). Increased ePAWP was associated with worse prognosis across all grades of diastolic function (HR normal: 1.07 [1.06-1.09]; indeterminate: 1.08 [1.07-1.09]; abnormal: 1.08 [1.07-1.09], p<0.001 for all).
CONCLUSIONS
CONCLUSIONS
Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction grading.
Identifiants
pubmed: 37949842
pii: 7394853
doi: 10.1093/ehjci/jead301
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.