Chronic heart failure; Diastolic function; Echocardiography; Filling pressures; Pulmonary capillary wedge pressure; Radiology, Nuclear Medicine and Imaging; Cardiology and Cardiovascular Medicine
Abstract :
[en] [en] BACKGROUND: An echocardiographic algorithm to estimate pulmonary capillary wedge pressure (ePCWP) and pulmonary vascular resistance (ePVR) has been recently validated versus right heart catheterization.
OBJECTIVE: To assess the prognostic significance of these measures in heart failure (HF) patients with reduced and mildly reduced ejection fraction.
METHODS: Consecutive outpatients with HF and left ventricular ejection fraction (LVEF) <50% undergoing echocardiography were selected and followed up for the composite end point of all-cause death or HF hospitalization.
RESULTS: Out of 2,214 patients (71 ± 12 years, 76% males, LVEF 35% ± 9%), ePCWP (16 ± 6 mm Hg) was elevated (>15 mm Hg) in 52% of cases and ePVR (1.7 ± 0.7 Wood units) was elevated (>2 Wood units) in 25% of cases. Patients with increased ePCWP were older and had a higher New York Heart Association class, more pronounced cardiac remodeling, systolic/diastolic dysfunction, and neurohormonal activation, particularly when ePVR was also elevated (P < .001). Over a median follow-up of 33 (17-48) months, both measures stratified patients for the risk of the primary end point (log-rank 151 for ePCWP and 60 for ePVR; P < .001). At adjusted regression analysis, ePCWP (hazard ratio for 1 mm Hg increase 1.03 [95% CI, 1.01-1.04]; P < .001) but not ePVR (P = .07) predicted the primary end point, even in patients with atrial fibrillation (P = .019), outperforming current diastolic dysfunction grading (P < .001) and both E/e' and left atrial volume index (P < .001). The addition of ePCWP to a multivariable prognostic model improved the accuracy of risk prediction (P < .001).
CONCLUSION: The echocardiographic estimates of PCWP retained clinical and prognostic significance in a large contemporary cohort of patients with chronic HF and LVEF <50%.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Bazan, Lorenzo; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
Gentile, Francesco; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
Sciarrone, Paolo; Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Buoncristiani, Francesco; Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Panichella, Giorgia; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
Gasparini, Simone; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
Taddei, Claudia; Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Poggianti, Elisa; Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Fabiani, Iacopo; Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Petersen, Christina; Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Lio, Giuseppe Emanuele; Department of Physics and European Laboratory for Non-linear Spectroscopy, University of Florence, Florence, Italy
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Passino, Claudio; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy, Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Emdin, Michele; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy, Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Chubuchny, Vladislav; Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Giannoni, Alberto ; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy, Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy. Electronic address: a.giannoni@santannapisa.it
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