Can Doppler echocardiography estimate raised pulmonary capillary wedge pressure provoked by passive leg lifting in suspected heart failure?

Abstract

Summary Aims Non‐invasive estimation of left ventricular filling pressure (LVFP) during stress is important for explaining exertional symptoms in patients with heart failure (HF). The aim of this study was to evaluate ability of Doppler echocardiographic measures of elevated LVFP with passive leg lifting (PLL) in patients with suspected HF. Methods Twenty‐nine patients with clinical signs of HF who underwent simultaneous Doppler echocardiography and right heart catheterization (RHC) at rest and during PLL were consecutively investigated. Seventeen patients had normal PCWP (≤15 mmHg) at rest and during PLL and 12 with normal PCWP at rest but >15 mmHg with PLL. Conventional echo and 2D strain were used to assess early diastolic blood flow velocity (E), LV strain rate during early diastole (LVSRe), left atrial SR during atrial contraction (LASRa) and myocardial tissue Doppler velocities to assess lateral e’ and further calculate E/e’ and E/LVSRe and their relationship with PCWP, at rest and during PLL. Results Resting LAVI (β = 0·45, P = 0·009) and LASRa (β = −0·51, P = 0·004) were independently related to PCWP during PLL. Also, LASRa (β = −0·77, P<0·001), E/e’ (β = 0·40, P = 0·04) and E/LVSRe (β = 0·47, P = 0·021) during PLL correlated with PCWP during PLL. Multiple regression analysis identified E/LVSRe (β = 0·46, P = 0·001) and LASRa (β = −0·58, P = 0·002) during PLL as being independently associated with PCWP during PLL. Conclusion Left atrial volume and myocardial contraction (LASRa) at rest both predict unstable LV filling pressures measured as raised PCWP when provoked by PLL. Furthermore, LASRa at PLL seems to have the strongest association to PCWP during PLL.

Diastolic function assessment by echocardiography: A practical manual for clinical use and future applications

“…Such increase in LV and LA pressures has its consequences in the form of pulmonary venous hypertension, pulmonary hypertension, and clinical symptoms of shortness of breath. Similar pathophysiological findings have been shown by simple leg lifting at rest 26,27 …”

“…Resting measures of LA volume and strain rate during atrial contraction predicted unstable PCWP (>15 mm Hg during PLL). Furthermore, the latter measured during PLL correlated well with PCWP during PLL 27 . Such simple procedure should be easily used in open access HF clinics for fast and accurate stratification of patients for optimum management (Figure 6).…”

Easy‐to‐use preload stress echocardiography by using combined dynamic postural stress can identify high‐risk patients with heart failure with reduced ejection fraction

“…Responses in SV with preload stress might be affected by baseline volume status and changes in cardiac afterload during postural alterations. However, the assessment of haemodynamics during the postural stress test was previously validated in comparison with invasive measurements 22 . Therefore, we believe that our overall results may not be significantly affected by these factors.…”

“…However, the assessment of haemodynamics during the postural stress test was previously validated in comparison with invasive measurements. 22 Therefore, we believe that our overall results may not be significantly affected by these factors. Third, ongoing medication was not withheld before the intervention for safety reasons.…”

Use of the HFA-PEFF algorithm for diagnosis of heartfailure with preserved left ventricular ejection fraction

“…В 2018 г. специалисты из Швеции провели исследование у 29 пациентов с симптомами СН, которым проводили эхокардиографию и катетеризацию правых камер сердца в покое и при нагрузке с пассивным подъемом ног. Было установлено, что у 41% пациентов с нормальным ДЗЛА в покое наблюдалось значительное его повышение при проведении пробы с пассивным подъемом ног [12]. Учитывая простоту выполнения пробы с пассивным подъемом ног, ее доступность, а также независимость от состояний, которые препятствуют проведению нагрузочных проб, представляется целесообразным проведение дальнейших исследований для оценки эффективности предложенного нами модифицированного алгоритма HFA-PEFF у большей популяции пациентов с симптомами СН.…”