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Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading
Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden; Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden; Kolling Institute, Royal North Shore Hospital, University of Sydney, Kolling Building, St Leonards, Sydney, New South Wales, Australia.
Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.ORCID iD: 0000-0002-8192-9166
Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden.
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2024 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 25, no 4, p. 498-509Article in journal (Refereed) Published
Abstract [en]

Background and aims: Grading of diastolic function can be useful, but indeterminate classifications are common.

Objectives: We aimed to invasively derive and validate a quantitative echocardiographic estimation of pulmonary artery wedge pressure (PAWP), and to compare its prognostic performance to diastolic dysfunction grading.

Methods: Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analyzed in the National Echocardiography Database of Australia (NEDA).

Results: In patients who had undergone both RHC and echocardiography within two hours (n=90), ePAWP was derived using left atrial volume index, mitral peak early velocity (E), and pulmonary vein systolic velocity (S). In a separate external validation cohort (n=53, simultaneous echocardiography and RHC), ePAWP showed good agreement with invasive PAWP (mean±SD difference 0.5±5.0 mmHg) and good diagnostic accuracy for estimating PAWP>15mmHg (area under the curve [95% confidence interval] 0.94 [0.88-1.00]). Among patients in NEDA (n=38,856, median [interquartile range] follow-up 4.8 [2.3-8.0] years, 2,756 cardiovascular deaths), ePAWP was associated with cardiovascular death even after adjustment for age, sex, and diastolic dysfunction grading (hazard ratio (HR) 1.08 [1.07-1.09] per mmHg) and provided incremental prognostic information to diastolic dysfunction grading (improved C-statistic from 0.65 to 0.68, p<0.001). Increased ePAWP was associated with worse prognosis across all grades of diastolic function (HR normal: 1.07 [1.06-1.09]; indeterminate: 1.08 [1.07-1.09]; abnormal: 1.08 [1.07-1.09], p<0.001 for all).

Conclusions: Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction grading.

Place, publisher, year, edition, pages
Oxford University Press, 2024. Vol. 25, no 4, p. 498-509
Keywords [en]
diastolic dysfunction, echocardiography, heart failure, pulmonary capillary wedge pressure
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-217450DOI: 10.1093/ehjci/jead301ISI: 001108246300001PubMedID: 37949842Scopus ID: 2-s2.0-85184482944OAI: oai:DiVA.org:umu-217450DiVA, id: diva2:1816735
Funder
Swedish Heart Lung Foundation, 20160787Swedish Heart Lung Foundation, 20200160Swedish Research Council, 2019-01338
Note

First published online: 9 November 2023

Available from: 2023-12-04 Created: 2023-12-04 Last updated: 2024-04-22Bibliographically approved

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