期刊
CIRCULATION-HEART FAILURE
卷 8, 期 4, 页码 749-U119出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCHEARTFAILURE.115.002161
关键词
dyspnea; echocardiography; heart failure; hemodynamics; pulmonary wedge pressure
资金
- Portuguese Foundation for Science and Technology [HMSP-ICJ/0013/2012]
- National Institutes of Health [1K08HL116792-01A1]
- American Heart Association [14CRP20380422]
- Fundação para a Ciência e a Tecnologia [HMSP-ICJ/0013/2012] Funding Source: FCT
Background-Elevated left ventricular filling pressure is a cardinal feature of heart failure with preserved ejection fraction. Mitral E/e' ratio has been proposed as a noninvasive measure of left ventricular filling pressure. We studied the accuracy of E/e' to estimate and track changes of left ventricular filling pressure in patients with unexplained dyspnea. Methods and Results-We performed supine and upright transthoracic echocardiography in 118 patients with unexplained dyspnea who underwent right heart catheterization. Supine E/e' ratio modestly but significantly correlated with supine pulmonary arterial wedge pressure (PAWP; r=0.36; P<0.001) and demonstrated poor agreement with PAWP values (Bland-Altman limits of agreement of -8.3 to 8.3 mm Hg; range, 6.5-21.2 mm Hg). Similarly, E/e' ratio cut off of 13 performed poorly in identifying patients with elevated left ventricular filling pressure (sensitivity 6%, specificity 90%). The receiver-operating characteristic area of E/e' was 0.65 (95% confidencce interval, 0.50-0.79). With change from the supine to upright position, PAWP decreased (-5+/-4 mm Hg; P<0.001) as did both E wave (-17+/-15 cm/s; P<0.001) and e' (-2.7+/-2.7 cm/s; P<0.001) velocities, whereas E/e' remained stable (+0.2+/-2.6; P=0.57). Positional change in PAWP correlated modestly with change in E-wave (r=0.37; P<0.001) velocity. There was no appreciable relationship between change in PAWP and change in average E/e' (r=-0.04; P=0.77) and in half the patients the change in PAWP and E/e' were directionally opposite. Conclusions-In patients with unexplained dyspnea, E/e' ratio neither accurately estimates PAWP nor identifies patients with elevated PAWP consistent with heart failure with preserved ejection fraction. Positional changes in E/e' ratio do not reflect changes in PAWP.
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