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Can Doppler echocardiography estimate raised pulmonary capillary wedge pressure provoked by passive leg lifting in suspected heart failure?
Author(s) -
Henein Michael Y.,
Tossavainen Erik,
A'roch Roman,
Söderberg Stefan,
Lindqvist Per
Publication year - 2019
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12547
Subject(s) - medicine , cardiology , pulmonary wedge pressure , heart failure , diastole , doppler echocardiography , doppler imaging , contraction (grammar) , hemodynamics , cardiac cycle , blood pressure
Summary Aims Non‐invasive estimation of left ventricular filling pressure ( LVFP ) during stress is important for explaining exertional symptoms in patients with heart failure ( HF ). The aim of this study was to evaluate ability of Doppler echocardiographic measures of elevated LVFP with passive leg lifting ( PLL ) in patients with suspected HF . Methods Twenty‐nine patients with clinical signs of HF who underwent simultaneous Doppler echocardiography and right heart catheterization ( RHC ) at rest and during PLL were consecutively investigated. Seventeen patients had normal PCWP (≤15 mmHg) at rest and during PLL and 12 with normal PCWP at rest but >15 mmHg with PLL . Conventional echo and 2D strain were used to assess early diastolic blood flow velocity (E), LV strain rate during early diastole ( LVSR e), left atrial SR during atrial contraction ( LASR a) and myocardial tissue Doppler velocities to assess lateral e’ and further calculate E/e’ and E/ LVSR e and their relationship with PCWP , at rest and during PLL . Results Resting LAVI (β = 0·45, P = 0·009) and LASR a (β = −0·51, P = 0·004) were independently related to PCWP during PLL . Also, LASR a (β = −0·77, P <0·001), E/e’ (β = 0·40, P = 0·04) and E/ LVSR e (β = 0·47, P = 0·021) during PLL correlated with PCWP during PLL . Multiple regression analysis identified E/ LVSR e (β = 0·46, P = 0·001) and LASR a (β = −0·58, P = 0·002) during PLL as being independently associated with PCWP during PLL . Conclusion Left atrial volume and myocardial contraction ( LASR a) at rest both predict unstable LV filling pressures measured as raised PCWP when provoked by PLL . Furthermore, LASR a at PLL seems to have the strongest association to PCWP during PLL .