Meta‐analysis of echocardiographic quantification of left ventricular filling pressure

Abstract

Aims The clinical reliability of echocardiographic surrogate markers of left ventricular filling pressures (LVFPs) across different cardiovascular pathologies remains unanswered. The main objective was to evaluate the evidence of how effectively different echocardiographic indices estimate true LVFP. Methods and results Design: this is a systematic review and meta‐analysis. Data source: Scopus, PubMed and Embase. Eligibility criteria for selecting studies were those that used echocardiography to predict or estimate pulmonary capillary wedge pressure or left ventricular end‐diastolic pressures. Twenty‐seven studies met criteria. Only eight studies (30%) reported both correlation coefficient and bias between non‐invasive and invasively measured LVFPs. The majority of studies (74%) recorded invasive pulmonary capillary wedge pressure as a surrogate for left ventricular end‐diastolic pressures. The pooled correlation coefficient overall was r = 0.69 [95% confidence interval (CI) 0.63–0.75, P < 0.01]. Evaluation by cohort demonstrated varying association: heart failure with preserved ejection fraction (11 studies, n = 575, r = 0.59, 95% CI 0.53–0.64) and heart failure with reduced ejection fraction (8 studies, n = 381, r = 0.67, 95% CI 0.61–0.72). Conclusions Echocardiographic indices show moderate pooled association to invasively measured LVFP; however, this varies widely with disease state. In heart failure with preserved ejection fraction, no single echocardiography‐based metric offers a reliable estimate. In heart failure with reduced ejection fraction, mitral inflow‐derived indices (E/e′, E/A, E/Vp, and EDcT) have reasonable clinical applicability. While an integrated approach of several echocardiographic metrics provides the most promise for estimating LVFP reliably, such strategies need further validation in larger, patient‐specific studies.

New insights into the potential utility of the left atrial function analysis in heart failure with preserved ejection fraction diagnosis

“…E/E′ has been the main non-invasive surrogate parameter to predict LVFP. However, many studies demonstrated that E/E′ ratio has a weak correlation with pulmonary capillary wedge pressure (PCWP) in patients with HFpEF [ 43 – 48 ]. Overall, there is a lack of strong evidence in HFpEF patients supporting the utility of E/E′ as an accurate marker of LVFP.…”

Diamond–Forrester classification using echocardiography haemodynamic assessment in cardiac intensive care unit patients

“…Finally, significant controversy exists within the literature regarding the use of the mitral E/e′ alone as a marker of diastolic dysfunction and elevated left ventricular filling pressures. 36 , 37 There are numerous clinical variables that can degrade the association between the E/e′ ratio and the left ventricular filling pressures, and we could neither identify the presence of these factors in our cohort nor could we confirm the presence of elevated left ventricular filling pressures via invasive haemodynamics assessment. 29 We did not have adequate data to formally grade diastolic dysfunction in this cohort according to current guidelines, which might have greater accuracy for elevated left ventricular filling pressures.…”

“…Furthermore, these echocardiographic data are merely a snapshot at a single time point in a patient's course, and fail to capture the inherent variability and changing nature of haemodynamics, particularly after ACS. Finally, significant controversy exists within the literature regarding the use of the mitral E/e′ alone as a marker of diastolic dysfunction and elevated left ventricular filling pressures 36,37 . There are numerous clinical variables that can degrade the association between the E/e′ ratio and the left ventricular filling pressures, and we could neither identify the presence of these factors in our cohort nor could we confirm the presence of elevated left ventricular filling pressures via invasive haemodynamics assessment 29 .…”

The Altmetric Attention Score: how science tries to meet social media

“…However, even within a niche field like HF, it is possible to analyse which issues gain more interest and are more requested, thus partially representing the ‘news value’ of a journal. Tables 2–5 report the top 10 articles published in 2019 and 2020 in the European Journal of Heart Failure and ESC Heart Failure , according to their Altmetric Attention Score 5–44 . 2020 was the year of…”