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Echocardiographic estimation of left ventricular filling pressures in heart transplant recipients
Zohreh Rahbar1, Anahita Tavoosi1, Alireza Bakhshandeh2
1Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran.
Insights
Echocardiography can estimate left ventricular filling pressure in heart transplant recipients. However, average E/e' ≥ 6.8 is the best cutoff for predicting elevated left ventricular end-diastolic pressure (LVEDP).
Area of Science:
- Cardiology
- Transplant Medicine
- Echocardiography
Background:
- Echocardiographic estimation of left ventricular filling pressure in heart transplant (HTx) recipients presents significant challenges.
- Accurate assessment of elevated left ventricular end-diastolic pressure (LVEDP) is crucial for post-transplant management.
Purpose of the Study:
- To assess the capability of echocardiography in detecting elevated LVEDP in HTx patients.
- To evaluate the correlation between echocardiographic parameters and invasive LVEDP measurements.
Main Methods:
- A descriptive cross-sectional study involving 39 HTx recipients undergoing routine endomyocardial biopsy.
- Doppler transthoracic echocardiography performed prior to biopsy, with simultaneous left heart catheterization.
- Analysis of parameters including lateral E/e', average E/e', and left ventricular global longitudinal strain against LVEDP.
Main Results:
- Strong correlations were observed between lateral E/e' and LVEDP (R=0.64, P<0.001) and average E/e' and LVEDP (R=0.6, P<0.001).
- The optimal cutoff for average E/e' to predict LVEDP ≥ 20 mmHg was ≥ 6.8, with 96.15% sensitivity and 68.5% specificity.
- A significant relationship was also found between LVEDP and left ventricular global longitudinal strain (R=-0.31, P<0.01).
Conclusions:
- Lateral E/e' demonstrated the strongest predictive capability for LVEDP, with average E/e' cutoff showing the best validity.
- Despite strong associations, echocardiographic parameters are not a complete surrogate for invasive LVEDP measurements in HTx recipients.
- Further research may refine echocardiographic models for LVEDP estimation in this population.
Background:
Echocardiographic estimation of left ventricular filling pressure in heart transplant (HTx) recipients is challenging. The ability of echocardiography to detect elevated left ventricular end-diastolic pressure (LVEDP) in HTx patients was assessed in this study.
Results:
This descriptive cross-sectional study included 39 HTx recipients who were candidates for endomyocardial biopsy as a part of their routine post-transplantation surveillance. Doppler transthoracic echocardiography was done before the procedure, and left heart catheterization was done during the endomyocardial biopsy. Thirty-nine patients (15 female, 24 male), with a mean age of 39.6 years (range 13-70), were enrolled. A strong relation was observed between lateral E/e' and LVEDP (R = 0.64, P value < 0.001) and average E/e' and LVEDP (R = 0.6, P value < 0.001). The best cutoff value for LVEDP prediction was the average E/e' ≥ 6.8 with a sensitivity of 96.15% and specificity of 68.5% for the prediction of LVEDP more than or equal to 20 mmHg. Two predictive models comprising age, gender, and lateral E/e' or average E/e' were also proposed. A significant relationship was also found between LVEDP and left ventricular global longitudinal strain (R = - 0.31, P value < 0.01).
Conclusions:
Lateral E/e' was the best predictor of LVEDP. The cutoff of average E/e' had the best validity for the estimation of LVEDP. Despite the strong observed association, echocardiographic parameters cannot be considered a surrogate for invasive LVEDP measurements when seeking information about left ventricle filling pressure on heart transplant recipients.
