Estimating Left Ventricular Filling Pressure by Echocardiography
Oyvind S Andersen1, Otto A Smiseth1, Hisham Dokainish2
1Oslo University Hospital, Rikshospitalet, Center for Cardiological Innovation and University of Oslo, Oslo, Norway.
Insights
Echocardiography accurately identifies elevated left ventricular (LV) filling pressure, a key heart failure indicator. Combining echocardiography with clinical data improves diagnostic accuracy, aiding clinicians in managing heart failure patients.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Heart Failure Research
Background:
- Diagnosing heart failure is challenging due to nonspecific symptoms.
- Elevated left ventricular (LV) filling pressure confirms heart failure but cardiac catheterization is often impractical.
- Echocardiographic indexes serve as non-invasive markers for filling pressure.
Purpose of the Study:
- To assess the feasibility and accuracy of comprehensive echocardiography in identifying patients with elevated LV filling pressure.
- To compare echocardiographic accuracy against clinical assessment and invasive measurements.
Main Methods:
- A multicenter study involving 450 patients with diverse cardiac conditions undergoing cardiac catheterization.
- Utilized left atrial volume index, flow velocities, and tissue Doppler to estimate LV filling pressure.
- Employed invasive pressure measurements as the gold standard for validation.
Main Results:
- Echocardiography achieved 87% accuracy in identifying elevated LV filling pressure, significantly outperforming clinical assessment (72%).
- The combination of clinical and echocardiographic data provided incremental diagnostic value, with a net reclassification improvement of 1.5.
- Elevated LV filling pressure was present in 58% of patients, with a mean LVEF of 47%.
Conclusions:
- Comprehensive echocardiography is a feasible and accurate method for assessing LV filling pressure.
- Integrating echocardiographic findings with clinical data enhances diagnostic accuracy for heart failure, irrespective of LVEF.
- Echocardiography offers a practical alternative to invasive methods for evaluating filling pressures.
Background:
The diagnosis of heart failure may be challenging because symptoms are rather nonspecific. Elevated left ventricular (LV) filling pressure may be used to confirm the diagnosis, but cardiac catheterization is often not practical. Echocardiographic indexes are therefore used as markers of filling pressure.
Objectives:
This study investigated the feasibility and accuracy of comprehensive echocardiography in identifying patients with elevated LV filling pressure.
Methods:
We conducted a multicenter study of 450 patients with a wide spectrum of cardiac diseases referred for cardiac catheterization. Left atrial volume index, in combination with flow velocities and tissue Doppler velocities, was used to estimate LV filling pressure. Invasively measured pressure was used as the gold standard.
Results:
Mean left ventricular ejection fraction (LVEF) was 47%, with 209 patients having an LVEF <50%. Invasive measurements showed elevated LV filling pressure in 58% of patients. Clinical assessment had an accuracy of 72% in identifying patients with elevated filling pressure, whereas echocardiography had an accuracy of 87% (p < 0.001 vs. clinical assessment). The combination of clinical and echocardiographic assessment was incremental, with a net reclassification improvement of 1.5 versus clinical assessment (p < 0.001).
Conclusions:
Echocardiographic assessment of LV filling pressure is feasible and accurate. When combined with clinical data, it leads to a more accurate diagnosis, regardless of LVEF.
