Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading

Thomas Lindow; Aristomenis Manouras; Per Lindqvist; Daniel Manna; Björn Wieslander; Rebecca Kozor; Geoff Strange; David Playford; Martin Ugander

doi:10.1093/ehjci/jead301

Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading

Eur Heart J Cardiovasc Imaging. 2024 Mar 27;25(4):498-509. doi: 10.1093/ehjci/jead301.

Authors

Thomas Lindow^{1

2

3

4}, Aristomenis Manouras⁵, Per Lindqvist⁶, Daniel Manna^{2

3}, Björn Wieslander^{2

7}, Rebecca Kozor⁴, Geoff Strange^{8

9

10

11}, David Playford⁸, Martin Ugander^{4

7}

Affiliations

¹ Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden.
² Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden.
³ Department of Research and Development, Region Kronoberg, Växjö, Sweden.
⁴ Kolling Institute, Royal North Shore Hospital, University of Sydney, Kolling Building, St Leonards, Sydney, New South Wales 2065, Australia.
⁵ Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
⁶ Department of Clinical Physiology, Surgical and Perioperative sciences, Umeå University, Umeå, Sweden.
⁷ Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden.
⁸ Institute for Health Research, School of Medicine, University of Notre Dame, Fremantle, Australia.
⁹ Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
¹⁰ Heart Research Institute, Sydney, Australia.
¹¹ Royal Prince Alfred Hospital, Sydney, Australia.

Abstract

Aims: Grading of diastolic function can be useful, but indeterminate classifications are common. 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 and results: Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analysed in the National Echocardiography Database of Australia (NEDA). In patients who had undergone both RHC and echocardiography within 2 h (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 ± standard deviation difference 0.5 ± 5.0 mmHg) and good diagnostic accuracy for estimating PAWP >15 mmHg [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, 2756 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].

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

Keywords: diastolic dysfunction; echocardiography; heart failure; pulmonary capillary wedge pressure.

MeSH terms

Cardiac Catheterization / methods
Echocardiography*
Echocardiography, Doppler* / methods
Humans
Prognosis
Pulmonary Artery
Pulmonary Wedge Pressure

Abstract

MeSH terms

Grants and funding