Meta-analysis of echocardiographic quantification of left ventricular filling pressure
Rachel Jones1, Frances Varian1,2, Samer Alabed1
1Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, S10 2RX, UK.
Insights
Echocardiography offers a moderate association with left ventricular filling pressures (LVFPs), but reliability varies by heart failure type. Mitral inflow indices show promise for heart failure with reduced ejection fraction, but more research is needed.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Research
Background:
- Left ventricular filling pressures (LVFPs) are crucial for diagnosing and managing heart failure.
- Echocardiography is a non-invasive tool, but its accuracy in estimating LVFPs across various cardiovascular conditions requires thorough evaluation.
Purpose of the Study:
- To systematically review and meta-analyze the existing evidence on the reliability of echocardiographic surrogate markers for estimating true LVFPs.
Main Methods:
- A systematic review and meta-analysis of studies using echocardiography to estimate LVFPs.
- Searched Scopus, PubMed, and Embase databases.
- Included 27 studies comparing echocardiographic indices with invasive measurements (pulmonary capillary wedge pressure or left ventricular end-diastolic pressures).
Main Results:
- The pooled correlation coefficient between echocardiographic indices and invasive LVFP was moderate (r=0.69).
- Association varied significantly by disease state: heart failure with preserved ejection fraction (r=0.59) and heart failure with reduced ejection fraction (r=0.67).
- Only 30% of studies reported both correlation and bias, and 74% used pulmonary capillary wedge pressure as a surrogate for LVFP.
Conclusions:
- Echocardiographic indices provide a moderate estimation of LVFPs, with performance dependent on the specific disease context.
- No single echocardiographic metric reliably estimates LVFP in heart failure with preserved ejection fraction.
- Mitral inflow-derived indices demonstrate reasonable clinical applicability in heart failure with reduced ejection fraction, suggesting potential for integrated approaches with further validation.
Aims:
The clinical reliability of echocardiographic surrogate markers of left ventricular filling pressures (LVFPs) across different cardiovascular pathologies remains unanswered. The main objective was to evaluate the evidence of how effectively different echocardiographic indices estimate true LVFP.
Methods And Results:
Design: this is a systematic review and meta-analysis.
Data Source:
Scopus, PubMed and Embase. Eligibility criteria for selecting studies were those that used echocardiography to predict or estimate pulmonary capillary wedge pressure or left ventricular end-diastolic pressures. Twenty-seven studies met criteria. Only eight studies (30%) reported both correlation coefficient and bias between non-invasive and invasively measured LVFPs. The majority of studies (74%) recorded invasive pulmonary capillary wedge pressure as a surrogate for left ventricular end-diastolic pressures. The pooled correlation coefficient overall was r = 0.69 [95% confidence interval (CI) 0.63-0.75, P < 0.01]. Evaluation by cohort demonstrated varying association: heart failure with preserved ejection fraction (11 studies, n = 575, r = 0.59, 95% CI 0.53-0.64) and heart failure with reduced ejection fraction (8 studies, n = 381, r = 0.67, 95% CI 0.61-0.72).
Conclusions:
Echocardiographic indices show moderate pooled association to invasively measured LVFP; however, this varies widely with disease state. In heart failure with preserved ejection fraction, no single echocardiography-based metric offers a reliable estimate. In heart failure with reduced ejection fraction, mitral inflow-derived indices (E/e', E/A, E/Vp, and EDcT) have reasonable clinical applicability. While an integrated approach of several echocardiographic metrics provides the most promise for estimating LVFP reliably, such strategies need further validation in larger, patient-specific studies.
