Optimal noninvasive assessment of left ventricular filling pressures - A comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters

Background - Early transmitral velocity/tissue Doppler mitral annular early diastolic velocity (E/Ea) and B-type natriuretic peptide (BNP) have been correlated with left ventricular filling pressures, yet there are no data on how these 2 estimates of left ventricular filling pressures compare. Methods and Results - Patients admitted to intensive care underwent simultaneous tissue Doppler echocardiography, BNP measurement, and pulmonary capillary wedge pressure (PCWP) determination. The ability of mitral E/Ea and BNP to predict PCWP > 15 mm Hg was assessed. Fifty patients were studied. Ln BNP had a correlation of r = 0.32 ( P = 0.02) with PCWP compared with r = 0.69 ( P < 0.001) between E/Ea and PCWP. E/Ea > 15 was the optimal cutoff to predict PCWP > 15 mm Hg ( sensitivity, 86%; specificity, 88%), whereas the optimal BNP cutoff was > 300 pg/mL ( sensitivity, 91%; specificity, 56%). The correlation between change in PCWP and change in E/Ea at 48 hours was r = 0.87 ( P = 0.003) compared with r = - 0.59 ( P = 0.39) for BNP. In the 36 patients with cardiac disease, E/Ea > 15 ( sensitivity, 92%; specificity, 91%) appeared more accurate than BNP > 400 pg/mL ( sensitivity, 92%; specificity, 51%), whereas in patients without cardiac disease, BNP ( sensitivity, 81%; specificity, 83%) appeared more accurate than E/Ea > 15 ( sensitivity, 74%; specificity, 72%) for PCWP > 15 mm Hg. Conclusions - In intensive care unit patients, mitral E/Ea has a better correlation than BNP with PCWP. Both BNP and mitral E/Ea have high sensitivity for PCWP > 15 mm Hg; however, E/Ea appears more specific in this patient population. In patients without cardiac disease, BNP appears more accurate than E/Ea for PCWP > 15 mm Hg, whereas E/Ea appears more accurate in patients with cardiac disease.