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Accuracy of Doppler echocardiography to estimate key hemodynamic variables in subjects with normal left ventricular
Micha T Maeder1, Sofie Karapanagiotidis, Elizabeth M Dewar
1Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Insights
Doppler echocardiography is not accurate for estimating hemodynamic parameters in patients with normal left ventricular ejection fraction (LVEF). Key parameters like pulmonary capillary wedge pressure (PCWP) showed poor correlation, limiting clinical reliability.
Area of Science:
- Cardiology
- Medical Imaging
- Hemodynamics
Background:
- The diagnostic accuracy of Doppler echocardiography for hemodynamic assessment in individuals with preserved left ventricular ejection fraction (LVEF) remains underexplored.
- Accurate hemodynamic monitoring is crucial for managing various cardiovascular conditions.
Purpose of the Study:
- To evaluate the accuracy of Doppler echocardiography in estimating key hemodynamic parameters compared to invasive right heart catheterization in subjects with normal LVEF.
- To determine the reliability of non-invasive echocardiographic measurements for critical hemodynamic values.
Main Methods:
- Thirty-six subjects with LVEF >50% underwent simultaneous Doppler echocardiography and right heart catheterization.
- Correlation coefficients and Bland-Altman analysis were used to compare invasive and non-invasive measurements.
- Receiver operating characteristic (ROC) curves assessed the predictive performance of echocardiography for specific hemodynamic thresholds.
Main Results:
- Significant correlations were found for systolic and mean pulmonary artery pressure (sPAP, mPAP), cardiac output (CO), and pulmonary vascular resistance (PVR) (r=0.70-0.72, r=0.57, r=0.60, respectively).
- No significant correlation was observed for pulmonary capillary wedge pressure (PCWP) (r=0.23).
- Bland-Altman analysis revealed substantial bias and wide limits of agreement for most non-invasive parameters, especially PCWP. ROC analysis showed good predictive value for sPAP and CO, but limited value for PVR and PCWP.
Conclusions:
- Doppler echocardiography parameters alone are insufficient for reliably estimating critical hemodynamic parameters, particularly PCWP, in patients with normal LVEF.
- The findings highlight limitations in using non-invasive echocardiography for precise hemodynamic assessment in this population.
- Further research may be needed to refine echocardiographic techniques or identify complementary methods for accurate hemodynamic evaluation.
Background:
The accuracy of Doppler echocardiography to estimate key hemodynamic parameters in subjects with normal left ventricular ejection fraction (LVEF) has not been fully investigated.
Methods And Results:
Thirty-six subjects with LVEF >50% (median age 62 years), with a broad clinical profile, underwent Doppler echocardiography immediately followed by right heart catheterization. Correlation coefficients between invasive and noninvasive right atrial pressure (RAP), systolic (sPAP) and mean (mPAP) pulmonary artery pressure, cardiac output (CO), and pulmonary vascular resistance (PVR) were 0.39, 0.70, 0.72, 0.57, and 0.60 (P < .001 for all). There was no significant correlation between invasive and noninvasive (based on the peak early transmitral to peak early septal mitral annular velocity ratio) pulmonary capillary wedge pressure (PCWP; r = 0.23; P = .18). Bland-Altman plots revealed variable bias but with consistently large limits of agreement for all noninvasive parameters, particularly PCWP. Areas under the receiver operating characteristic curve for noninvasive sPAP, CO, PVR, and PCWP to predict an invasively assessed mPAP ≥25 mm Hg, cardiac index <2.5 L min(-1) m(-2), PVR >3 Wood units, and PCWP ≤15 mm Hg, respectively, were 0.92, 0.83, 0.70, and 0.58.
Conclusions:
Single Doppler echocardiography parameters are not accurate enough to reliably estimate key hemodynamic parameters, particularly PCWP, in subjects with normal LVEF.
