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Echo Doppler Estimation of Pulmonary Capillary Wedge Pressure in Patients with Severe Aortic Stenosis
Author(s) -
Biner Simon,
Topilsky Yan,
Banai Shmuel,
Steinvil Arie,
Arbel Yaron,
Siegel Robert James,
Beigel Roy,
Keren Gad,
Finkelstein Ariel
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12893
Subject(s) - medicine , pulmonary wedge pressure , cardiology , ejection fraction , stenosis , hemodynamics , radiology , heart failure , doppler echocardiography , prospective cohort study , cohort , blood pressure , diastole
Background Transcatheter aortic valve replacement ( TAVR ) has become a treatment option for patients with severe aortic stenosis ( AS ) and high surgical risk. Assessment of symptoms in these patients is challenging because of advanced age, comorbidities, and limited physical activity. Noninvasive quantification of pulmonary capillary wedge pressure ( PCWP ) in candidates for TAVR may be helpful for risk stratification. The objective of the study was to create a model for estimation of PCWP by echo D oppler in patients with severe AS . Methods and Results Data from 80 patients with severe AS referred for TAVR were used to develop an echo D oppler model for predicting PCWP . Its performance was evaluated in the test cohort of 33 patients who had invasive and noninvasive evaluation. No single echo D oppler parameter estimated PCWP accurately. In the retrospective analysis, the multilinear regression provided an accurate estimate of PCWP (r 2 = 0.74). The model included, in order of importance (all P < 0.05), the ratio of early transmitral velocity (E) to annular velocity (E’), the left ventricular ejection fraction, and the velocity time integral of tricuspid regurgitation signal. In the prospective cohort of patients with severe AS, the model demonstrated good predictive ability of PCWP (r = 0.77, P < 0.01). Conclusion In patients with severe AS , noninvasive estimation of PCWP is possible by integration of two‐dimensional, spectral, and tissue D oppler variables.