Related Experiment Video
Updated: Sep 27, 2026
Pulsed Wave Doppler Assessment of Diastolic Dysfunction in the ZSF-1 Rat Model of Pulmonary Hypertension Due to Left Heart Disease
Published on: May 22, 2026
Contrast-enhanced Doppler hemodynamics for noninvasive assessment of patients with chronic heart failure and left
Frank Lloyd Dini1, Egidio Traversi, Mirella Franchini
1Unità Operativa di Cardiologia, Villamarina Hospital, Pisa, Italy. frank.dini@tiscali.it
Insights
Contrast-enhanced Doppler echocardiography significantly improves noninvasive hemodynamic assessment in patients with left ventricular (LV) dysfunction. This technique enhances accuracy and feasibility for estimating key variables like pulmonary artery pressure.
Area of Science:
- Cardiology
- Medical Imaging
- Hemodynamics
Background:
- Left ventricular (LV) dysfunction impacts cardiac output and pressures.
- Accurate hemodynamic assessment is crucial for managing LV dysfunction.
- Noninvasive methods often face limitations in feasibility and accuracy.
Purpose of the Study:
- To evaluate the efficacy of contrast-enhanced Doppler echocardiography (DCE) in improving noninvasive hemodynamic variable estimation.
- To compare DCE with standard Doppler echocardiography in patients with LV dysfunction.
- To assess the impact of DCE on the accuracy and feasibility of measuring cardiac output, pulmonary capillary wedge pressure, pulmonary artery mean pressure, and pulmonary vascular resistance.
Main Methods:
- Simultaneous right-heart catheterization and Doppler echocardiography in 45 patients with LV dysfunction.
- Noninvasive variables estimated using pulsed Doppler, regression equations, and hemodynamic definitions.
- Contrast enhancement utilized to assess its impact on feasibility and accuracy.
- Correlation and agreement analyses performed between invasive and noninvasive measurements.
Main Results:
- Contrast enhancement increased feasibility for pulmonary capillary wedge pressure (60% to 100%), pulmonary artery mean pressure (42% to 91%), and pulmonary vascular resistance (42% to 91%).
- Strong correlations found between invasive and noninvasive measurements post-contrast (e.g., r=0.90 for cardiac output, r=0.93 for pulmonary artery mean pressure).
- Contrast-enhanced assessment correctly classified 88% of patients based on pulmonary vascular resistance thresholds, compared to 57% without contrast.
Conclusions:
- Contrast-enhanced Doppler echocardiography significantly enhances the accuracy and feasibility of noninvasive hemodynamic assessment in LV dysfunction.
- This technique improves the estimation of critical hemodynamic variables, aiding clinical decision-making.
- DCE reduces interobserver variability and increases the overall value of noninvasive hemodynamic evaluation in this patient population.
Abstract:
We sought to evaluate whether contrast-enhanced Doppler echocardiography can improve the noninvasive estimation of hemodynamic variables in left ventricular (LV) dysfunction. Right-heart catheterization and Doppler echocardiography were simultaneously performed in 45 patients with LV dysfunction (ejection fraction: 29 +/- 7%) in sinus rhythm. Noninvasive variables were estimated as follows: cardiac output by pulsed Doppler of LV outflow tract; pulmonary capillary wedge pressure by a regression equation including mitral and pulmonary venous flow variables; pulmonary artery mean pressure from the calculated systolic and diastolic pulmonary artery pressures; and pulmonary vascular resistance from the previous measurements according to hemodynamic definition. Contrast enhancement increased the feasibility of pulmonary capillary wedge pressure estimation from 60% to 100%; of pulmonary artery mean pressure from 42% to 91%; and of pulmonary vascular resistance from 42% to 91%. Strong correlations between invasive and noninvasive hemodynamic variables were found: r = 0.90, standard error of the estimate (SEE) 0.45 L/min for cardiac output; r = 0.90, SEE 3.1 mm Hg for pulmonary capillary wedge pressure; r = 0.93, SEE 3.7 mm Hg for pulmonary artery mean pressure; and r = 0.85 SEE 1.0 Wood units for pulmonary vascular resistance. Weaker correlations for PAMP (r = 0.82, SEE 5.6 mm Hg) and PVR (r = 0.66, SEE 1.7 Wood units) were apparent prior to contrast enhancement. When patients were separated according to PVR threshold values, the contrast allowed the correct placement of 88% of patients, whereas only 57% were correctly assigned without it. The contrast increased accuracy and reduced interobserver variability in the evaluation of hemodynamic variables. The contrast-enhanced study is capable of increasing the value of noninvasive hemodynamic assessment in LV dysfunction.
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