Application of an echocardiographic scoring system of left ventricular filling pressure to diagnose acute heart failure in patients complaining dyspnea

Tamaki, Yoji; Iwano, Hiroyuki; Murayama, Michito; Ishizaka, Shoji; Motoi, Ko; Aoyagi, Hiroyuki; Nakamura, Kosuke; Goto, Mana; Suzuki, Yasuyuki; Yokoyama, Shinobu; Nishino, Hisao; Nakabachi, Masahiro; Kaga, Sanae; Kamiya, Kiwamu; Nagai, Toshiyuki; Anzai, Toshihisa

doi:10.1016/j.jjcc.2023.04.016

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…In addition to the low specificity of the guideline-recommended algorism, the present study further elucidated that VMT score was successfully applied for the AS patients. Physiologically, the VMT score stands for early equivalation of LV and LA pressures in early diastole along with elevated RA pressure, 10,13,14 which can be universal events in left-sided heart failure. Therefore, it is consequent that increased VMT score reflects elevated LV FP in AS patients.…”

Section: Usefulness Of Vmt Score In As Patientsmentioning

confidence: 99%

“…Although the diagnostic utility of the VMT score has been validated in several studies from single center, 10,13,14,34 it lacks prospective study including large population consisted of various clinical condition.…”

Section: Future Perspectivementioning

confidence: 99%

“…Recently proposed echocardiographic scoring system to estimate LV FP, VMT score was assessed in accordance with the previous reports. 10,13,14 Based on earlier opening of the mitral valve (MV) than tricuspid valve (TV) in the presence of a higher LV filling pressure compared to right atrial (RA) pressure, 10 this scoring system consists of a visual assessment of the time sequence of atrioventricular valve openings and estimated RA pressure based on inferior vena cava (IVC) findings. At first, from the apical or subcostal four-chamber views, the time sequence of MV and TV opening was assessed and scored into three grades (0 = TV opening first, 1 = simultaneous, and 2 = MV opening first).…”

Section: Vmt Scoringmentioning

confidence: 99%

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Non‐invasive assessment of left ventricular filling pressure in aortic stenosis

Aoyagi,

Iwano,

Tamaki

et al. 2024

Echocardiography

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BackgroundThe assessment of left ventricular (LV) filling pressure (FP) is important for the management of aortic stenosis (AS) patients. Although, it is often restricted for predict LV FP in AS because of mitral annular calcification and a certain left ventricular hypertrophy. Thus, we tested the predictive ability of the algorithm for elevated LV FP in AS patients and also applied a recently‐proposed echocardiographic scoring system of LV FP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score.MethodsWe enrolled consecutive 116 patients with at least moderate AS in sinus rhythm who underwent right heart catheterization and echocardiography within 7 days. Mean pulmonary artery wedge pressure (PAWP) was measured as invasive parameter of LV FP. LV diastolic dysfunction (DD) was graded according to the ASE/EACVI guidelines. The VMT score was defined as follows: time sequence of opening of mitral and tricuspid valves was scored to 0–2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). When the inferior vena cava was dilated, one point was added and VMT score was finally calculated as 0–3.ResultsOf the 116 patients, 29 patients showed elevated PAWP. Ninety patients (93%) and 67 patients (63%) showed increased values for left atrium volume index (LAVI) and E/e′, respectively when the cut‐off values recommended by the guidelines were applied and thus the algorism predicted elevated PAWP with a low specificity and positive predictive value (PPV). VMT ≥ 2 predicted elevated PAWP with a sensitivity of 59%, specificity of 90%, PPV of 59%, and negative predictive value of 89%. An alternative algorithm that applied tricuspid regurgitation velocity and VMT scores was tested, and its predictive ability was markedly improved.ConclusionVMT score was applicable for AS patients. Alternative use of VMT score improved diagnostic accuracy of guideline‐recommended algorism.

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Section: Usefulness Of Vmt Score In As Patientsmentioning

confidence: 99%

Section: Future Perspectivementioning

confidence: 99%

Section: Vmt Scoringmentioning

confidence: 99%

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Non‐invasive assessment of left ventricular filling pressure in aortic stenosis

Aoyagi,

Iwano,

Tamaki

et al. 2024

Echocardiography

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Validation of Left Ventricular Filling Pressure Evaluation by Order of Tricuspid and Mitral Valve Opening in Patients With Atrial Fibrillation

Nishino,

Murayama,

Iwano

et al. 2024

Circ: Cardiovascular Imaging

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BACKGROUND: Accurate assessment of left ventricular filling pressure in patients with atrial fibrillation or flutter (AF) remains difficult. A novel 2-dimensional scoring system, visually assessing time difference between mitral valve and tricuspid valve opening (VMT) score, based on temporal analysis of early diastolic valve opening, could be applied to these patients. We aimed to determine the usefulness of the VMT score in patients with AF. METHODS: We analyzed 119 consecutive patients with AF who underwent cardiac catheterization as a derivation cohort. The diagnostic performance of the VMT score was further evaluated in an external data set containing 189 patients with AF. Elevated left ventricular filling pressure was defined as a mean pulmonary arterial wedge pressure ≥15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0, tricuspid valve first; 1, simultaneous; 2, mitral valve first). When the inferior vena cava was dilated, 1 point was added, and the VMT score was finally graded as 0 to 3. Conventional Doppler parameters to estimate left ventricular filling pressure were also measured. RESULTS: Pulmonary arterial wedge pressure was elevated with an increase in the VMT score (0: 10±3, 1: 13±5, 2: 22±7, 3: 27±6 mm Hg; P <0.001), resulting in a significant rise in pulmonary arterial wedge pressure from VMT score 1 to 2. VMT≥2 predicted elevated pulmonary arterial wedge pressure with an accuracy of 87%, and the diagnostic accuracy of the VMT score was significantly higher than that of conventional Doppler parameters ( C index, 0.88 versus 0.54–0.68; P <0.001). In addition, VMT ≥2 showed an incremental predictive value over plasma brain natriuretic peptide levels ( C index, 0.79–0.93; P <0.001). In the external validation cohort, VMT≥2 demonstrated acceptable accuracy of 72%. CONCLUSIONS: VMT scoring was a useful echocardiographic marker of elevated left ventricular filling pressure and had an incremental benefit over practical biomarkers in patients with AF.

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Novel Approach to Estimate Left Ventricular Filling Pressure in Patients With Atrial Fibrillation

Kuznetsova

2024

Circ: Cardiovascular Imaging

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Application of an echocardiographic scoring system of left ventricular filling pressure to diagnose acute heart failure in patients complaining dyspnea

Cited by 4 publications

References 25 publications

Non‐invasive assessment of left ventricular filling pressure in aortic stenosis

Non‐invasive assessment of left ventricular filling pressure in aortic stenosis

Validation of Left Ventricular Filling Pressure Evaluation by Order of Tricuspid and Mitral Valve Opening in Patients With Atrial Fibrillation

Novel Approach to Estimate Left Ventricular Filling Pressure in Patients With Atrial Fibrillation

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