Meta‐analysis of echocardiographic quantification of left ventricular filling pressure

Jones, Rachel, Varian, Frances, Alabed, Samer, Morris, Paul, Rothman, Alexander, Swift, Andrew J., Lewis, Nigel, Kyriacou, Andreas, Wild, James M., Al‐Mohammad, Abdallah, Zhong, Liang, Dastidar, Amardeep, Storey, Robert F., Swoboda, Peter P., Bax, Jeroen J. and Garg, Pankaj (2021) Meta‐analysis of echocardiographic quantification of left ventricular filling pressure. ESC Heart Failure, 8 (1). pp. 566-576. ISSN 2055-5822

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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.

Item Type: Article
Additional Information: Funding Information: This work was supported by Wellcome Trust grants (A.R.—206632/Z/17/Z), (P.G.‐220703/Z/20/Z) and (A.J.S.—205188/Z/16/Z). L.Z. was supported by the National Medical Research Council (NMRC/OFIRG/0018/2016). P.G. was supported by the Academy of Sciences Starter Grant (SGL018\1100). Publisher Copyright: © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology
Uncontrolled Keywords: echocardiography,invasive heart catheterization,left ventricular end-diastolic pressure,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 17 Nov 2021 04:51
Last Modified: 24 Nov 2021 03:13
URI: https://ueaeprints.uea.ac.uk/id/eprint/82128
DOI: 10.1002/ehf2.13119

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