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Mitral E-wave to stroke volume ratio displays stronger diagnostic performance to identify elevated left ventricular filling pressures than mitral E/e' during passive leg lift: a cross-sectional study employing simultaneous echocardiography and catheterization
Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.ORCID iD: 0000-0002-8192-9166
2024 (English)In: Echocardiography, ISSN 0742-2822, E-ISSN 1540-8175, Vol. 41, no 2, article id e15756Article in journal (Refereed) Published
Abstract [en]

Background: Elevated filling pressure is a hallmark of heart failure (HF) and portends poor prognosis. Accurate diagnosis is challenging, given that patients with normal filling pressure at rest develop disproportionate elevation with sudden preload increase. We aimed to test the accuracy of the ratio between mitral inflow velocity (E) and left ventricular stroke volume (SV) to identify patients with elevated filling pressure with passive leg lifting (PLL) and compare this with other echocardiographic surrogates of filling pressure.

Methods: Doppler echocardiography and right heart catheterization (RHC) were simultaneously performed in 37 patients (11 males, mean age 67 ± 12 years) with exertional dyspnea. Twenty-six healthy controls (14 males, mean age 60 ± 12 years) were added as reference. SV, cardiac output (CO), tricuspid regurgitation peak gradient (TRG), mitral E-wave (E) and early myocardial velocity (e') were obtained at rest and with PLL. E/SV, E/CO and E/e' were calculated and correlated with invasive pulmonary capillary wedge pressures (PCWP) with PLL.

Results: During PLL, E/SV (AUC = 0.94) displayed stronger diagnostic ability to identify PCWP >15 mmHg than E/e' (AUC = 0.81), mitral E/A ratio (0.76) and resting invasive PCWP (0.84). An E/SV cutoff of >1.0 showed 88% sensitivity and 75% specificity to identify elevated PCWP. Further, 10 patients (27%) were reassigned during PLL from normal to postcapillary pulmonary hypertension (postCPH), and 6 patients (16%) switched diagnosis from precapillary PH (preCPH) to postCPH.

Conclusion: The novel E/SV ratio identifies patients with elevated PCWP with PLL and displays stronger diagnostic performance than routinely utilized echocardiographic measures such as E/e' in addition to resting, catheterization derived PCWP.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024. Vol. 41, no 2, article id e15756
Keywords [en]
Doppler, filling pressure, heart failure, passive leg lifting, pulmonary hypertension
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-221481DOI: 10.1111/echo.15756PubMedID: 38400581Scopus ID: 2-s2.0-85184507860OAI: oai:DiVA.org:umu-221481DiVA, id: diva2:1840576
Funder
Swedish Research Council, 2019-01338Swedish Research Council, 2022-01254Swedish Heart Lung Foundation, 20160787Swedish Heart Lung Foundation, 20200160Available from: 2024-02-26 Created: 2024-02-26 Last updated: 2024-03-07Bibliographically approved

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Lindqvist, Per

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