Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indices
Background: Left heart filling pressures, as measured by pulmonary artery wedge pressure (PAWP), is associated with heart failure related mortality. Because of the prognostic importance of PAWP, several echocardiographic indices have been proposed for noninvasive assessment of PAWP. However, these i...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-02-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906719302027 |
| _version_ | 1818522071650533376 |
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| author | Alexander C. Egbe Keerthana Banala Rahul Vojjini Raja Jadav Mahir Sufian Patricia A. Pellikka Naser M. Ammash |
| author_facet | Alexander C. Egbe Keerthana Banala Rahul Vojjini Raja Jadav Mahir Sufian Patricia A. Pellikka Naser M. Ammash |
| author_sort | Alexander C. Egbe |
| collection | DOAJ |
| description | Background: Left heart filling pressures, as measured by pulmonary artery wedge pressure (PAWP), is associated with heart failure related mortality. Because of the prognostic importance of PAWP, several echocardiographic indices have been proposed for noninvasive assessment of PAWP. However, these indices have not been validated in the congenital heart disease population. The purpose of this study was to determine the correlation between echocardiographic indices of PAWP, and the effect of high PAWP on transplant-free survival in adults with tetralogy of Fallot (TOF). Methods: Retrospective study of adult TOF patients that underwent cardiac catheterization at Mayo Clinic, 1990–2017. We selected these pre-defined set of echocardiographic indices of LV diastolic function: mitral valve early velocity (E), mitral valve early and late velocity ratio (E/A), mitral valve deceleration time (DT), mitral annular tissue Doppler early velocity (e′), and left atrial volume index (LAVI). Results: Of the echocardiographic indices analyzed among 213 patients (age 37 ± 14 years), only E velocity (β = 5.83, standard error = 1.52, p < 0.001) and LAVI (β = 0.14, standard error = 0.05, p = 0.007) correlated with PAWP. LAVI > 28 ml/m2 had sensitivity of 79% and specificity of 63% (AUC 0.712), and E velocity > 1.0 m/s had sensitivity of 66% and specificity of 89% (AUC 0.692), for detecting PAWP > 15 mmHg. LAVI > 28 ml/m2 was associated with reduced 10-year transplant-free survival (49% vs 90%, p < 0.001). Conclusion: This study supports the use of LAVI for noninvasive assessment of PAWP and for prognostication. Further studies are required to validate these results in a different population. Keywords: Tetralogy of Fallot, Left heart filling pressure, Pulmonary artery wedge pressure, Echocardiography |
| first_indexed | 2024-12-11T05:28:30Z |
| format | Article |
| id | doaj.art-23f40979f8744d0cbfe0b0c77a94f1eb |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-11T05:28:30Z |
| publishDate | 2020-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-23f40979f8744d0cbfe0b0c77a94f1eb2022-12-22T01:19:30ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672020-02-0126Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indicesAlexander C. Egbe0Keerthana Banala1Rahul Vojjini2Raja Jadav3Mahir Sufian4Patricia A. Pellikka5Naser M. Ammash6Corresponding author at: Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, United States.; The Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United StatesThe Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United StatesThe Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United StatesThe Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United StatesThe Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United StatesThe Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United StatesThe Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United StatesBackground: Left heart filling pressures, as measured by pulmonary artery wedge pressure (PAWP), is associated with heart failure related mortality. Because of the prognostic importance of PAWP, several echocardiographic indices have been proposed for noninvasive assessment of PAWP. However, these indices have not been validated in the congenital heart disease population. The purpose of this study was to determine the correlation between echocardiographic indices of PAWP, and the effect of high PAWP on transplant-free survival in adults with tetralogy of Fallot (TOF). Methods: Retrospective study of adult TOF patients that underwent cardiac catheterization at Mayo Clinic, 1990–2017. We selected these pre-defined set of echocardiographic indices of LV diastolic function: mitral valve early velocity (E), mitral valve early and late velocity ratio (E/A), mitral valve deceleration time (DT), mitral annular tissue Doppler early velocity (e′), and left atrial volume index (LAVI). Results: Of the echocardiographic indices analyzed among 213 patients (age 37 ± 14 years), only E velocity (β = 5.83, standard error = 1.52, p < 0.001) and LAVI (β = 0.14, standard error = 0.05, p = 0.007) correlated with PAWP. LAVI > 28 ml/m2 had sensitivity of 79% and specificity of 63% (AUC 0.712), and E velocity > 1.0 m/s had sensitivity of 66% and specificity of 89% (AUC 0.692), for detecting PAWP > 15 mmHg. LAVI > 28 ml/m2 was associated with reduced 10-year transplant-free survival (49% vs 90%, p < 0.001). Conclusion: This study supports the use of LAVI for noninvasive assessment of PAWP and for prognostication. Further studies are required to validate these results in a different population. Keywords: Tetralogy of Fallot, Left heart filling pressure, Pulmonary artery wedge pressure, Echocardiographyhttp://www.sciencedirect.com/science/article/pii/S2352906719302027 |
| spellingShingle | Alexander C. Egbe Keerthana Banala Rahul Vojjini Raja Jadav Mahir Sufian Patricia A. Pellikka Naser M. Ammash Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indices International Journal of Cardiology: Heart & Vasculature |
| title | Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indices |
| title_full | Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indices |
| title_fullStr | Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indices |
| title_full_unstemmed | Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indices |
| title_short | Left ventricular filling pressure in Tetralogy of Fallot: Correlation between invasive and noninvasive indices |
| title_sort | left ventricular filling pressure in tetralogy of fallot correlation between invasive and noninvasive indices |
| url | http://www.sciencedirect.com/science/article/pii/S2352906719302027 |
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