Comparison of the reliability of E/E′ to estimate pulmonary capillary wedge pressure in heart failure patients with preserved ejection fraction versus those with reduced ejection fraction

Abstract

Accurate assessment of pulmonary capillary wedge pressure (PCWP) is essential for physicians to effectively manage patients with acute decompensated heart failure. The ratio of early transmittal velocity to tissue Doppler mitral annular early diastolic velocity (E/E') is used to estimate PCWP noninvasively in a wide range of cardiac patients. However, it remains contentious as to whether mitral E/E' is a reliable predictor of PCWP. In the present study, acute heart failure patients were divided into two groups on the basis of left ventricular (LV) systolic function: those with preserved ejection fraction (HFpEF) and those with reduced ejection fraction (HFrEF). The usefulness of mitral E/E' in estimating PCWP was compared between the two groups. Fifty consecutive patients who were admitted with acute decompensated heart failure and underwent both right-sided cardiac catheterization and transthoracic echocardiography during hospitalization were analyzed retrospectively. Pearson's correlation was used to evaluate associations between Doppler parameters and PCWP. E/E' was positively correlated with PCWP (r = 0.56, P = 0.01) in the heart failure with preserved ejection fraction group. However, no significant relationship was observed between PCWP and mitral E/E' (P = 0.85) in the heart failure with reduced ejection fraction group. There were no significant correlations between any of the conventional parameters considered (LVEF, left atrial dimension, E/A, IVRT, and DT) with PCWP in either group. In conclusion, mitral E/E' is useful for estimating PCWP in patients with acute heart failure with preserved ejection fraction but may not in those with reduced ejection fraction.

Acutely decompensated heart failure with preserved and reduced ejection fraction present with comparable haemodynamic congestion

“…Consistent with prior studies, our study confirmed that acute HFpEF predominantly affects old hypertensive women who present with acute dyspnoea and hypoxaemia. We further showed, using imaging and circulating biomarkers, that acute HFpEF and acute HFrEF shared similar features: (i) increased natriuretic peptides, (ii) increased pulmonary pressure, (iii) altered RV function, (iv) enlarged IVC, (v) altered renal function, and (vi) poor outcomes.…”

Correlation with invasive left ventricular filling pressures and prognostic relevance of the echocardiographic diastolic parameters used in the 2016 ESC heart failure guidelines and in the 2016 ASE/EACVI recommendations: a systematic review in patients with heart failure with preserved ejection fraction

“…Most studies excluded patients in atrial fibrillation. Five studies used PCWP and four studies used LVEDP as reference parameter. Invasive measurements were simultaneous or directly after echo in seven out of nine studies.…”

“…Nine studies with invasive haemodynamic measurements are listed in Table . Most of these studies included a low number of patients ( n = 10–20), with only three studies having more than 40 HFpEF patients included.…”

The application of lung ultrasound in acute decompensated heart failure in heart failure with preserved and reduced ejection fraction

“…In the HFrEF group, a cutoff of ≥30 B-lines showed a comparable sensitivity of 86% and a specificity of 78% (AUC: 0.84, 95% CI: 0.811-0.866) ( Figure 3). 16 Matsushita et al 17 reported that E/eʹ was positively correlated with pulmonary capillary wedge pressure (r=0.56, P=.01) in the HF with preserved ejection fraction group.…”