scholarly journals Left atrial strain rate during atrial contraction predicts raised pulmonary capillary wedge pressure: evidence for left atrio-ventricular interaction

2021 ◽  
Author(s):  
Per Lindqvist ◽  
Michael Henein
Keyword(s):  
Strain Rate ◽  
Pulmonary Capillary Wedge Pressure ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Left Atrial Strain ◽  
Heart Chamber ◽  
Pulmonary Capillary ◽  
Atrial Contraction ◽  
The Relationship ◽  
Wedge Pressure

AbstractThis study aimed to assess the relationship between different LA strain components and PCWP as well as to the relationship with other established methods. We studied 144 symptomatic patients, age 63 ± 14 years, 54 males, using conventional transthoracic echocardiography protocols, including LA and LV myocardial deformation from speckle tracking technique investigations along with simultaneous right heart catheterization (RHC) using established techniques. From RHC, pulmonary artery pressure (PAP), and pulmonary capillary wedge pressure (PCWP) were measured and pulmonary vascular resistance (PVR) calculated. LA strain rate during atrial contraction (LASRa) was the strongest correlate with PCWP (r2 =  − 0.40, p < 0.001), over and above both LASR during LV systole (LASRs) and LA longitudinal strain during ventricular systole (LASs) (r2 = 0.21 and 0.19, respectively, p < 0.001 for both). The correlation between LASRa and PCWP was stronger in patients with post-capillary PH compared to pre-capillary PH (r2 = 0.21 vs. r2 = 0.02, respectively). The strongest relationship between LASRa and PCWP was in patients with enlarged LA volume > 34 ml/m2 (r2 = 0.60, p < 0.001). In all patients LASRa <  = 0.9 1/s was 88% accurate in predicting LA pressure > 15 mmHg which was superior to recently proposed uni- and multi-variable models. LASR during atrial contraction is the strongest predictor of PCWP, particularly in patients with post-capillary PH and with dilated LA cavity. Furthermore, it proved superior to recently proposed uni- and multi-variable based algorithms. Its close relationship with LV strain rate counterpart reflects important left heart chamber interaction in patients with raised LA pressure.

Abstract 2693: Mitral E/E’ underestimates Pulmonary Capillary Wedge Pressure During Exercise.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sébastien Marchandise ◽  
Anne-Marie D’Hondt ◽  
Olivier Gurne ◽  
David Vancraeynest ◽  
Bernhard Gerber ◽  
...  
Keyword(s):  
Pulmonary Capillary Wedge Pressure ◽  
Right Heart Catheterization ◽  
Exercise Heart Rate ◽  
Heart Catheterization ◽  
Limited Data ◽  
Pulmonary Capillary ◽  
Lateral Decubitus ◽  
The Right ◽  
The Relationship ◽  
Wedge Pressure

Background. Previous studies have shown that resting LV filling pressures can be estimated noninvasively by use of the ratio of the early diastolic transmitral filling velocity (E) to the early diastolic septal tissue velocity (E’). Yet, limited data exist regarding the accuracy of this measurement during exercise. In this study, we therefore sought to evaluate the possible value of exercise E/E’ for predicting invasively measured pulmonary capillary wedge pressure (PCWP). Methods. 22 patients (57 ± 15 years, 10 males) with heart failure (n=14), valve disease (n=6) or pulmonary hypertension (n=2) underwent right heart catheterization during symptom limited bicycle exercise. For each patient, PCWP and Doppler measurements of E/E’ were acquired in left lateral decubitus, after 5 min of sitting and during the last minute of each exercise stage. Results. With exercise, heart rate increased from 78 ± 17 bpm to 118 ± 21 bpm, as did systolic blood pressure (from 128 ± 29 to 169 ± 30 mmHg, p<0.001), PCWP (from 15 ± 6 to 24 ± 9 mmHg, p<0.001), E velocity (from 84 ± 34 to 111 ± 41 cm.s -1 p<0.001) and septal E’ (from 6.2 ± 2.7 to 9.0 ± 4.3 cm.s -1 p<0.01). At rest, in both recumbent and sitting positions, E/E’ correlated well with PCWP (solid circle, y = 0.7856 X + 4.2084, r = 0.72). During exercise, E/E’ also correlated with PCWP (open circle, y = 0.5253x + 1.7168, r = 0.64). The relationship was nonetheless shifted downward and to the right compared to rest. Conclusion. While E/E’ correlates with PCPW both at rest and during exercise, the relationship between these 2 parameters is different under these 2 conditions. Therefore, E/E’ values defining elevated LV filling pressures at rest cannot be used during exercise.

scholarly journals Room for improvement in pulmonary capillary wedge pressure reporting: a review of hemodynamic tracings at a large academic medical center

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402092915 ◽  
Author(s):  
Shelsey W. Johnson ◽  
Alison Witkin ◽  
Josanna Rodriguez-Lopez ◽  
Richard Channick
Keyword(s):  
Pulmonary Capillary Wedge Pressure ◽  
Diastolic Pressure ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Left Heart ◽  
Right Heart ◽  
Pulmonary Capillary ◽  
Left Heart Catheterization ◽  
Wedge Pressure

To describe the frequency with which pulmonary capillary wedge pressure measurements, obtained during right heart catheterization, are falsely elevated and to educate operators on techniques to improve accuracy of pulmonary capillary wedge pressure reporting. Failure to completely occlude pulmonary artery branch vessels during balloon inflation can lead to falsely elevated, “incomplete” pulmonary capillary wedge pressures. Balloon deflation prior to catheter retraction may result in catheter advancement into smaller branch vessels, yielding an inadvertent but more accurate alternative pulmonary capillary wedge pressure. We hypothesized that this phenomenon can be identified on retrospective review of right heart catheterization tracings, which occurs commonly and goes unrecognized by operators. We conducted a retrospective study of patients undergoing right heart catheterization or right heart catheterization and left heart catheterization with computer-generated pulmonary capillary wedge pressure ≥20 from January 2015 to June 2017. Alternative pulmonary capillary wedge pressures were defined as a pulmonary capillary wedge pressure trace during balloon deflation ≥3 mmHg lower than the reported pulmonary capillary wedge pressure. Inter-rater reliability of tracing reviewers was also evaluated. Results showed that, of the 182 tracings reviewed, an alternative pulmonary capillary wedge pressure was identified in 26 or 14.3% of cases. Eleven of these alternative pulmonary capillary wedge pressures were ≤15 mmHg with a calculated pulmonary vascular resistance ≥3 Wood units in 10 patients, re-classifying the etiology of pulmonary hypertension from post-capillary to pre-capillary in 38.5% of cases. For the eight patients for whom left heart catheterization data were available, left ventricular end-diastolic pressure aligned with the alternative pulmonary capillary wedge pressure. In conclusion, inadvertently obtained, but likely more accurate, alternative pulmonary capillary wedge pressures were identified in almost 15% of procedures reviewed from a busy academic institution. As wedge pressures often drive diagnosis and treatment decisions for patients with cardiac and pulmonary pathology, operators should be attuned to balloon deflation as a time when alternative pulmonary capillary wedge pressures may be identified as they are likely more reflective of left ventricular end-diastolic pressure. Additional tools to ensure accuracy of pulmonary capillary wedge pressure reporting are reviewed.

Pulmonary hypertension

2018 ◽  
Author(s):  
Robert MacKenzie-Ross ◽  
Karen K. K. Sheares ◽  
Joanna Pepke-Zaba
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Capillary Wedge Pressure ◽  
Pressure Measurement ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Pulmonary Capillary ◽  
Pathophysiological Condition ◽  
Wedge Pressure

Pulmonary hypertension (PH) is a haemodynamic and pathophysiological condition defined as mean pulmonary artery pressure ≥25 mm Hg at rest, assessed by right-heart catheterization (8–20 mm Hg is considered normal). A pulmonary capillary wedge pressure measurement of >15 mm Hg indicates a significant pulmonary venous component. PH is associated with a variety of causes. The current PH classification is helpful in understanding the different etiological, pathological, and treatment approaches.

scholarly journals Ratio of Mixed Venous Oxygen Saturation-to-Pulmonary Capillary Wedge Pressure: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

2022 ◽  
Author(s):  
Dustin Hillerson ◽  
Richard Charnigo ◽  
Sun Moon Kim ◽  
Amrita Iyengar ◽  
Matthew Lane ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Pulmonary Capillary Wedge Pressure ◽  
Right Heart Catheterization ◽  
Mixed Venous Oxygen Saturation ◽  
Heart Catheterization ◽  
Right Heart ◽  
Pulmonary Capillary ◽  
Venous Oxygen Saturation ◽  
Wedge Pressure ◽  
Mixed Venous

Background: Hemodynamic values from right heart catheterization aid diagnosis and clinical decision-making but may not predict outcomes. Mixed venous oxygen saturation percentage and pulmonary capillary wedge pressure relate to cardiac output and congestion, respectively. We theorized that a novel, simple ratio of these measurements could estimate cardiovascular prognosis. Methods: We queried Veterans Affairs’ databases for clinical, hemodynamic, and outcome data. Using the index right heart catheterization between 2010 and 2016, we calculated the ratio of mixed venous oxygen saturation-to-pulmonary capillary wedge pressure, termed ratio of saturation-to-wedge (RSW). The primary outcome was time to all-cause mortality; secondary outcome was 1-year urgent heart failure presentation. Patients were stratified into quartiles of RSW, Fick cardiac index (CI), thermodilution CI, and pulmonary capillary wedge pressure alone. Kaplan-Meier curves and Cox proportional hazards models related comparators with outcomes. Results: Of 12 019 patients meeting inclusion criteria, 9826 had values to calculate RSW (median 4.00, interquartile range, 2.67–6.05). Kaplan-Meier curves showed early, sustained separation by RSW strata. Cox modeling estimated that increasing RSW by 50% decreases mortality hazard by 19% (estimated hazard ratio, 0.81 [95% CI, 0.79–0.83], P <0.001) and secondary outcome hazard by 28% (hazard ratio, 0.72 [95% CI, 0.70–0.74], P <0.001). Among the 3793 patients with data for all comparators, Cox models showed RSW best associated with outcomes (by both C statistics and Bayes factors). Furthermore, pulmonary capillary wedge pressure was superior to thermodilution CI and Fick CI. Multivariable adjustment attenuated without eliminating the association of RSW with outcomes. Conclusions: In a large national database, RSW was superior to conventional right heart catheterization indices at assessing risk of mortality and urgent heart failure presentation. This simple calculation with routine data may contribute to clinical decision-making in this population.

scholarly journals P1384 Longitudinal strain in basal, midventricular and apical segments in aortic stenosis and mitral regurgitation and the relationship to pulmonary capillary wedge pressure at exercise

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Hartmund Frederiksen ◽  
N L Christensen ◽  
R Bakkestroem ◽  
R C Storch ◽  
A Banke ◽  
...  
Keyword(s):  
Heart Disease ◽  
Pulmonary Capillary Wedge Pressure ◽  
Longitudinal Strain ◽  
Stress Test ◽  
Volume Overload ◽  
Lv Function ◽  
Pulmonary Capillary ◽  
The Relationship ◽  
Wedge Pressure ◽  
Group 1

Abstract Funding Acknowledgements Supported by the Danish Heart Foundation Background Two dimensional speckle tracking provide reproducible regional and global assessment of left ventricular (LV) function. Valvular heart disease imposes both pressure overload (aortic stenosis (AS) and volume overload (mitral regurgitation (MR) on the LV. Despite high prevalence of valvular heart disease, little is known about the relationship between longitudinal strain (LS) measures and exercise hemodynamics in the pressure over loaded LV AS and the volume over loaded LV in MR. Purpose To describe the relationship between segmental LS in AS and MR according to normal or increased pulmonary capillary wedge pressure with exercise. Methods In a cross-sectional study patients with asymptomatic AS (aortic valve area &lt;1 cm2 and peak velocity &gt;3.5 m/s) and patients with primary MR (effective regurgitant orifice &gt; 0.30 cm2) underwent echocardiography and stress test in semi-supine position with invasive hemodynamic assessment using a Swan-Ganz catheter. Echocardiograms were performed at rest on a Vivid 9 (GE, Horten, Norway) and stored for offline analysis. Semi-automatic software (Echopac version 202, GE) was used for LS analysis and recorded using an 18-segment model of the LV followed by segmentation into basal (BAS), midventricular (MID) and apical (API) segments. Semi-supine stress test was performed with increase in workload every third minute until exhaustion; at maximum exercise, pulmonary capillary wedge pressure was measured (maxPCWP). Patients were grouped according to maxPCWP &gt; 28 mmHg (group 1) or ≤ 28 mmHg (group 2). Results are shown as mean ± SD, student’s t-test was used for continues data and pearsons chi-squared test was used for categorical data. Results Thirty-five patients with AS (age 73 ± 7.0 years, 74% men), and in 44 patients with MR (age 64 ± 8.8 years, 77% men) were studied. Patients with AS had a global LS of -18.8 ± 3.3% vs. -21.5 ± 3.3% in MR patients (p = 0.001). Basal, midventricular and apical LS was -14.5%±2.2%, -18.4 ± 2.9% and -26.3 ± 5.5% in AS patients and -18.4 ± 2.6%, -21.9 ± 2.9% and -26.7 ± 5.1% in MR patients (p &lt; 0.001, p &lt; 0.001 and 0.442, respectively). The proportion of AS patients that were in group 1(n = 23) were higher than the proportion of MI patients that were in group 1 (n = 19, 66 % vs 42%, p = 0.046). Patients in group 1 had lower LS in all segments (BAS: -15.7 ± 2.8% vs -17.7 ± 3.1%, MID: -19.3 ± 2.9% vs. -21.6 ± 3.4%, API: -26.0 ± 5.0% vs -27.8 ± 5.4%) but only BAS and MID segments were statistically significant(p = 0.005 and p = 0.002, respectively). In both AS and MR, patients in group 1 had lower segmental LS, but only MID LS in MR patients was statistically significant (-20.9%±2.5% vs -22.7 ± 2.9%, p = 0.030). Conclusion In patients with AS or MR PCWP above 28 mmHg with exercise was associated with lower LS in BAS and MID segments. This implies that in both pressure and volume overload resting LV function is depressed when patients have abnormally elevated filling pressure with exercise. Abstract P1384 Figure. Longitudinal strain

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