Echocardiography can accurately estimate pulmonary artery wedge pressure without left atrial volume information – diagnostic and prognostic performance

A quantitative estimate of pulmonary artery wedge pressures (PAWP) can be obtained using echocardiography, but including left atrial (LA) volume (ePAWP-LA) in the estimation may be misleading. We aimed to derive and validate a new estimate without LA volume information (ePAWP-NOLA) and compare its performance to the ASE/EACVI algorithms for diastolic dysfunction.

Methods

ePAWP-NOLA was derived and validated in separate datasets of patients who had undergone right heart catheterization and echocardiography. Prognosis was assessed in the validation cohort and the National Echocardiography Database Australia (NEDA) using Cox regression adjusted for age, sex and left ventricular ejection fraction (LVEF).

Results

In the derivation cohort (60±15 years, 40% males, 31% with LVEF<50%), ePAWP-NOLA was derived from mitral (E), and pulmonary vein systolic (S) and diastolic (D) Doppler velocities (n=134, mean difference±SD vs PAWP: 0.0±5.5 mmHg). In the validation cohort (n=116, 51±14 years, 69% males, 89% with LVEF<50%), PAWP agreed with both ePAWP-NOLA and ePAWP-LA (difference 1.3±6.1, 3.2±6.3 mmHg). PAWP>15 mmHg was accurately detected by both ePAWP-NOLA and ePAWP-LA (area under the curve (AUC): 0.84 [0.76–0.92], 0.80 [0.72–0.88]). AUC for the ASE/EACVI algorithm was lower ([0.69 [0.61–0.77]). ePAWP-NOLA and ePAWP-LA correlated with right ventricular afterload, associated with death or implantation of left ventricular assist device (hazard ratio: 1.09 [1.02–1.16], 1.07 [1.02–1.14]), and with cardiovascular death in NEDA (n=38,844, hazard ratio: 1.08 [1.07–1.09], 1.08 [1.07–1.09]).

Conclusions

ePAWP-NOLA has diagnostic and prognostic performance comparable to ePAWP-LA, and improved diagnostic performance compared to the ASE/EACVI diastolic dysfunction algorithm.