title: Echocardiographic predictors of change in left ventricular diastolic pressure in heart failure patients receiving nesiritide.
abstract: BACKGROUND
  To evaluate the usefulness of currently accepted echocardiographic parameters of diastolic function to assess the acute change in left ventricular end-diastolic pressure (LVEDP) following the administration of nesiritide in a heart failure population.
  
  
  METHODS
  In 25 heart failure patients (15 with systolic dysfunction, 10 with preserved ejection fraction [EF]), Doppler echocardiography, right and left heart catheterization, and invasive biventricular pressure hemodynamics were obtained at baseline and 30 minutes after nesiritide infusion.
  
  
  RESULTS
  Twenty-four patients had sufficient echocardiographic images for analysis. The mean age was 60 +/- 11 years, 48% were male, 56% had coronary artery disease, and 64% had hypertension. Right ventricular systolic pressure (RVSP) had the highest correlation with LV filling pressure: pulmonary capillary wedge pressure (PCWP), pre-A wave LV, and LVEDP (r = 0.66, P = 0.0009; r = 0.63, P = 0.002; r = 0.72, P = 0.0002, respectively). Following nesiritide administration, the mean PCWP decreased from 17.1 +/- 7.8 mmHg at baseline to 9.6 +/- 6.2 mmHg (P < 0.001). Change in RVSP had the highest correlation with change in PCWP (r =-0.67, P = 0.10) and change in LVEDP (r =-0.71, P = 0.07).
  
  
  CONCLUSIONS
  Echocardiographic parameters are frequently assessed in attempts to estimate left heart diastolic pressures. In heart failure patients, RVSP appears to be the best predictor of LVEDP, outperforming tissue Doppler E/E'. RVSP was found to be the best echocardiographic predictor of change in LV filling pressure with intravenous vasodilator therapy in heart failure patients. RVSP may provide a noninvasive means of assessing response to cardiac therapy.
authors.affiliation: Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Weeks
authors.forename: Mia
authors.initials: M
authors.lastname: Shapiro
authors.forename: Elyse
authors.initials: E
authors.lastname: Foster
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Michaels
mesh_terms: D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000008:administration & dosage; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage*; D011379:Prognosis; D013318:Stroke Volume / Q000187:drug effects*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000188:drug therapy*
chemical_list: D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain