A novel ultrasound predictor of pulmonary capillary wedge pressure assessed by the combination of left atrial volume and function: A speckle tracking echocardiography study

作者：Kawasaki Masanori^*; Tanaka Ryuhei; Ono Koji; Minatoguchi Shingo; Watanabe Takatomo; Iwama Makoto; Hirose Takeshi; Arai Masazumi; Noda Toshiyuki; Watanabe Sachiro; Zile Michael R; Minatoguchi Shinya

来源：Journal of Cardiology, 2015, 66(3-4): 253-262.

DOI：10.1016/j.jjcc.2014.11.008

• Atrial volume
• Atrial function
• Diastolic dysfunction
• Speckle tracking echocardiography
• Pulmonary capillary wedge pressure

Background: We hypothesized that a development of a novel index based on the combination of left atrial volume (LAV) and left atrial (LA) function evaluated by the time-LA volume curve using speckle tracking echocardiography (STE) would be accurate and useful to estimate pulmonary capillary wedge pressure (PCWP). Our goal was to develop a novel index of PCWP based on a combination of LAV and LA function using STE.
Methods: A cross-validation study was performed with the patients divided into a training study to define the novel index (n = 50) and a testing study to validate the index (n = 196). PCWP was measured by right heart catheterization, and phasic LAV and emptying EF) were measured by STE.
Results: Simple linear regression analysis in the training study revealed that the novel index that best estimated PCWP was the kinetics-tracking index [KT index = log(10) (active LAEF/minimum LAV index)]. Multiple regression analysis revealed that the KT index was the most reliable predictor of PCWP. It had the strongest correlation with PCWP (r = -0.86, p < 0.001) among all echocardiographic parameters. In the testing study, PCWP estimated by the KT index was also strongly correlated with measured PCWP (r = 0.92, p < 0.001). These correlations were also strong in the patients with reduced left ventricular ejection fraction (<50%), chronic heart failure, and chronic atrial fibrillation (r = 0.92, r = 0.91, r = 0.79, p < 0.001, respectively).
Conclusions: A novel index (KT index) using a combination of LAV and LA function was a powerful and useful predictor of PCWP and may be valuable in routine clinical practice.

• 出版日期2015-10