Background
Methods
Study population
Cardiac catheterization
Standard echocardiography
Tissue Doppler Imaging
Speckle Tracking Echocardiography
Reproducibility
Statistical analysis
Results
Patients characteristics
PCWP <18 mmHg (n = 15) | PCWP ≥18 mmHg (n = 21) | p Value | |
---|---|---|---|
Clinical data
| |||
Age
| 57.7 ± 8.1 | 57.3 ± 8.6 | 0.77 |
Gender (% female) | 43.2 | 42.3 | 0.65 |
Body surface area (m2) | 1.95 ± 0.2 | 1.94 ± 0.2 | 0.70 |
Hypertension
| 20 (89%) | 12 (88%) | 0.66 |
Diabetes mellitus
| 8 (36%) | 5 (35%) | 0.81 |
Hypercholesterolemia
| 17 (77%) | 10 (75%) | 0.51 |
Current smoker
| 2 (9%) | 2 (12%) | 0.44 |
Ischemic cause (%) | 81% | 82% | 0.65 |
CRT-D
| 4 (28.6%) | 7 (33.3%) | 0.21 |
Medical therapy
| |||
Ace-inhibitors or ARB
| 10 (66.6%) | 14 (66.6%) | 0.81 |
Beta-blockers
| 8 (53.3%) | 11 (52.3%) | 0.66 |
Spironolactone
| 7 (46.7%) | 9 (42.8%) | 0.22 |
Loop diuretics
| 13 (86.7%) | 18 (85.7) | 0.44 |
Statins
| 9 (60.0%) | 14 (66.7%) | 0.32 |
Echocardiographic data
| |||
Left atrial area (cm2) | 26.9 ± 5.9 | 33.1 ± 6.6 | 0.02 |
Left atrial volume indexed (ml/m2) | 30.2 ± 9 | 41.1 ± 10.1 | 0.009 |
End-diastolic LV diameter (mm) | 57.3 ± 8.3 | 63.0 ± 8.0 | 0.01 |
LV mass index (g/m2) | 116.6 ± 31.3 | 118.3 ± 33.5 | 0.21 |
LV Ejection Fraction (%) | 26.5 ± 3.5 | 25.7 ± 4.3 | 0.15 |
Mitral E (cm/s) | 82.6 ± 33 | 99.4 ± 46 | <0.001 |
Mitral E/A ratio
| 2.19 ± 1.1 | 3.66 ± 1.3 | <0.001 |
Sm (cm/s) | 5.0 ± 1.1 | 5.0 ± 1.2 | 0.81 |
Em (cm/s) | 6.6 ± 1.8 | 6.2 ± 1.8 | 0.24 |
E/Em (cm/s) | 12.6 ± 6.4 | 15.9 ± 7.9 | 0.01 |
Global PALS (%) | 16.9 ± 4.0 | 9.8 ± 4.2 | <0.001 |
4-chamber PALS (%) | 14.3 ± 3.8 | 8.0 ± 3.6 | <0.001 |
2-chamber PALS (%) | 18.0 ± 4.6 | 11.2 ± 4.5 | <0.001 |
Global TPLS (ms) | 445 ± 81 | 410 ± 78 | 0.09 |
Catheterization data
| |||
Heart rate (bpm) | 73.3 ± 15.3 | 76.0 ± 15.1 | 0.20 |
Systolic blood pressure (mmHg) | 118 ± 19 | 116 ± 21 | 0.28 |
Diastolic blood pressure (mmHg) | 79 ± 11 | 76 ± 13 | 0.27 |
Mean PAP (mmHg) | 21.8 ± 7.8 | 32.1 ± 9.9 | <0.001 |
PCWP (mmHg) | 13.1 ± 5.1 | 23.8 ± 7.4 | <0.001 |
CI therm (ml/min/m2) | 2.12 ± 0.7 | 2.13 ± 0.9 | 0.40 |
CI fick (ml/min/m2) | 1.99 ± 0.4 | 1.97 ± 0.4 | 0.42 |
Invasive hemodynamic and echocardiographic measurements
Correlation between echocardiographic and invasive measurements
Diagnostic accuracy of noninvasive estimate of elevated filling pressure
Cutoff value | Sensitivity (95% CI)(%) | Specificity (95% CI)(%) | AUC | |
---|---|---|---|---|
Two-dimensional Echo
| ||||
LV EDV
| >278 ml | 50.0 (15.6-85.6) | 88.2 (46.3-99.6) | 0.60 |
LA area
| >36.5 cm2
| 60.0 (32.4-84.1) | 50.0 (16.1-85.3) | 0.68 |
LA volume indexed
| >37.8 ml/m2
| 67.9 (53.9-96.8) | 87.5 (56.9-95.7) | 0.78 |
Mitral flow Doppler
| ||||
Mitral E wave
| > 94.2 cm/s | 90.1 (66.8-99.7) | 66.8 (26.3-93.2) | 0.72 |
E/A ratio
| >2.6 | 89.4 (65.1-97.2) | 65.2 (24.3-92.9) | 0.70 |
Tissue Doppler
| ||||
Mean E/Em ratio
| >16.8 | 67.9 (27.8-91.5) | 93.1 (76.9-99.8) | 0.69 |
Speckle tracking
| ||||
Global PALS
| <15.1% | 100 (83.9-100) | 93.2 (78.1-99.8) | 0.93 |