Echocardiographic Evaluation of Left Ventricular Filling Pressure in Patients With Heart Failure With Preserved Ejection Fraction: Usefulness of Inferior Vena Cava Measurements and 2016 EACVI/ASE Recommendations

JOURNAL OF CARDIAC FAILURE

卷:26

Article

Berthelot, Emmanuelle^1,2  Jourdain, Patrick^1,2  Bailly, Minh Tam^1,2  Bouchachi, Amir^1,2  Gellen, Barnabas³  Rouquette, Alexandra^4,5  Damy, Thibaud^6,7,8  Herve, Philippe⁹  Chemla, Denis^1,10  Assayag, Patrick^1,2 

[1] Univ Paris Saclay, Le Kremlin Bicetre, France

[2] Hop Bicetre, AP HP, Serv Cardiol, Le Kremlin Bicetre, France

[3] ELSAN Polyclin Poitiers, Serv Cardiol, Poitiers, France

[4] Hop Bicetre, AP HP, Serv Sante Publ & Epidemiol, Le Kremlin Bicetre, France

[5] Univ Paris Saclay, UVSQ, INSERM, CESP, Paris, France

[6] Henry Mondor Hosp, AP HP, Creteil, France

[7] Dept Cardiol, Creteil, France

[8] INSERM UPEC U955, Heart Failure & Amyloidosis Unit, GRC Amyloid Res Inst, Creteil, France

[9] Marie Lannelongue Hosp, Dept Thorac Surg, Le Plessis Robinson, France

[10] Hop Bicetre, AP HP, Serv Physiol, Le Kremlin Bicetre, France

关键词: Heart failure;    left ventricular filling pressure;    diagnosis;    echocardiography;    right heart catheterization;   

DOI  :  10.1016/j.cardfail.2020.01.018

来源: Elsevier

【 摘 要 】

Context: The left ventricular filling pressure (LVFP) is correlated to right atrial pressure (RAP) in heart failure. We compared diagnostic value of the inferior vena cava (IVC) measurements to the one of the 2016 echocardiographic recommendations to estimate LVFP in patients with suspected heart failure with preserved ejection fraction (HFpEF). Methods: Invasive hemodynamics and echocardiography were obtained within 48 hours in 132 consecutive patients with left ventricular ejection fraction >= 50%, and suspected pulmonary hypertension. Increased LVFP was defined by a pulmonary artery wedge pressure (PAWP) >15 mmHg. Results: Of 83 patients in sinus rhythm, a score of the 2016 recommendations >= 2 (E/e' ratio > 14 and/or tricuspid regurgitation velocity >2.8 m/s and/or indexed left atrial volume>34 mL/m(2)) had a positive predictive value (PPV) of 63% for PAWP>15 mmHg, whereas a dilated IVC (>2.1 cm) and/or non-collapsible (<= 50%) had a PPV of 82%. The net reclassification improvement was 0.39 (P <.05). In atrial fibrillation (AF), a dilated and/or non-collapsible IVC had an 86% PPV for PAWP>15 mmHg. The correlation between RAP and PAWP was 0.60, with 75.7% concordance (100/132) between dichotomized pressures (both RAP>8 mmHg and PAWP>15 mmHg and vice versa). Conclusion: The IVC size and collapsibility is valuable to identify patients with HFpEF with high LVFP in both sinus rhythm and AF.

【 授权许可】

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