Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading-Reference-Cited by-同舟云学术

Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading

Published:2023-11-09 Issue: Volume: Page:
ISSN:2047-2404
Container-title:European Heart Journal - Cardiovascular Imaging
language:en
Short-container-title:

Author:

Lindow Thomas¹²³⁴^ORCID,Manouras Aristomenis⁵^ORCID,Lindqvist Per⁶^ORCID,Manna Daniel²³,Wieslander Björn²⁷^ORCID,Kozor Rebecca⁴^ORCID,Strange Geoff⁸⁹¹⁰¹¹^ORCID,Playford David⁸^ORCID,Ugander Martin⁴⁷^ORCID

Affiliation:

1. Clinical Physiology, Clinical Sciences, Lund University , Lund , Sweden

2. Department of Clinical Physiology, Växjö Central Hospital , Växjö , Sweden

3. Department of Research and Development, Region Kronoberg , Växjö , Sweden

4. Kolling Institute, Royal North Shore Hospital, University of Sydney , Kolling Building, St Leonards, Sydney, New South Wales 2065 , Australia

5. Department of Cardiology, Karolinska University Hospital, Karolinska Institutet , Stockholm , Sweden

6. Department of Clinical Physiology, Surgical and Perioperative sciences, Umeå University , Umeå , Sweden

7. Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet , Stockholm 17176 , Sweden

8. Institute for Health Research, School of Medicine, University of Notre Dame , Fremantle , Australia

9. Faculty of Medicine and Health, University of Sydney , Sydney , Australia

10. Heart Research Institute , Sydney , Australia

11. Royal Prince Alfred Hospital , Sydney , Australia

Abstract

Abstract Aims 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. Methods and results Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analysed in the National Echocardiography Database of Australia (NEDA). In patients who had undergone both RHC and echocardiography within 2 h (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 ± standard deviation difference 0.5 ± 5.0 mmHg) and good diagnostic accuracy for estimating PAWP >15 mmHg [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, 2756 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]. Conclusion Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction grading.

Funder

New South Wales Health

Heart Research Australia

University of Sydney

Region Kronoberg

The Swedish Heart and Lung Foundation

Swedish Research Council

Actelion Pharmaceuticals

Bayer Pharmaceuticals

GlaxoSmithKline

National Health and Medical Research Council

NEDA Ltd