Validation of an echo-Doppler decision model to predict left ventricular filling pressure in patients with heart failure independently of ejection fraction.
OBJECTIVE
To test a decision model for non-invasive estimation of left ventricular filling pressure (LVFP) in patients with left ventricular (LV) dysfunction and a wide range of ejection fractions (EF).


RESULTS
In patients with LV dysfunction (n = 270; EF = 42 +/- 16%), classification and regression tree (CART) analysis was used to generate a model for the prediction of elevated LVFP, defined as pulmonary capillary wedge pressure (PCWP) >15 mmHg, in a derivation cohort (n = 178). At each step of the decision tree, nodes including single or multiple criteria connected by Boolean operators were tested to achieve the best information entropy gain. Averaged mitral-to-myocardial early velocities ratio (E/e') > or =13 OR E-wave deceleration time <150 ms was closely associated with elevated LVFP. Alternatively, prediction of PCWP >15 mmHg needed the following criteria to be satisfied: (i) intermediate E/e' (13 > E/e' > 8); (ii) left atrial volume index >40 mL/m(2) OR ratio of mitral E-wave and colour M-mode propagation velocity >2 OR difference in duration of pulmonary vein and mitral flow at atrial contraction >30 ms; (iii) estimated pulmonary artery systolic pressure >35 mmHg. Patients were correctly allocated according to PCWP with an 87% sensitivity and a 90% specificity. Compared with the best single parameter estimating LVFP, a 17% relative increase in accuracy was achieved in patients with EF >50%. The model was prospectively validated in a testing group (n = 92): 80% sensitivity, 78% specificity.


CONCLUSIONS
This sequential testing is useful to non-invasively predict LVFP in patients with LV dysfunction, especially in those with preserved EF.
Dini
Frank Lloyd
FL
Cardiovascular Diseases Unit 1, Cardiac, Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2, Pisa 56124, Italy. f.dini@ao-pisa.toscana.it
Ballo
Piercarlo
P
Badano
Luigi
L
Barbier
Paolo
P
Chella
Piersilvio
P
Conti
Umberto
U
De Tommasi
Salvatore Mario
SM
Galderisi
Maurizio
M
Ghio
Stefano
S
Magagnini
Enrico
E
Pieroni
Andrea
A
Rossi
Andrea
A
Rusconi
Cesare
C
Temporelli
Pier Luigi
PL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003661:Decision Support Techniques; D003663:Decision Trees; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000473:pathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000473:pathology; D016277:Ventricular Function, Left