Echocardiographic estimation of pulmonary capillary wedge pressure using the combination of diastolic annular and mitral inflow velocities

BACKGROUND: We aimed to identify the clinical utility of a simple echocardiographic approach for estimating the pulmonary capillary wedge pressure (PCWP) on the basis of the combined assessment of mitral inflow and tissue Doppler mitral annular velocities. METHODS: We retrospectively enrolled 165 patients who underwent both echocardiographic examination and right heart catheterization, and determined the diagnostic accuracy of echocardiography-derived parameters for estimating PCWP >18 mmHg. RESULTS: Eighty-three patients had preserved left ventricular (LV) ejection fraction ≥50% (the PEF group) and 82 patients had reduced LVEF <50% (the REF group). The PEF group had higher peak early mitral annular velocity (E′) compared with the REF group. Eight patients in the PEF group but none in the REF group had normal LV diastolic function, represented as E′ >8 cm/s, and all of these patients had normal inflow pattern. The mean PCWP had the strongest correlation with the ratio of the peak early mitral inflow velocity (E) to the peak late diastolic mitral inflow velocity during atrial contraction (E/A) in both groups, followed by the left atrial diameter and E/E′ in both patient groups. Receiver operating characteristic (ROC) analysis demonstrated that the combination of abnormal E′ ≤8 and elevated E/A had high diagnostic accuracy compared with E/E′ in both patient groups with different cutoff values of E/A (1.81 in the PEF group and 1.16 in the REF group) for predicting mean PCWP >18 mmHg. CONCLUSION: After excluding patients with normal diastolic function using E′, conventional E/A is a reliable marker for predicting high PCWP and is superior to E/E′.