title: Tissue Doppler imaging-derived myocardial acceleration during isovolumetric contraction predicts pulmonary capillary wedge pressure in patients with reduced ejection fraction.
abstract: BACKGROUND
  Tissue Doppler imaging-obtained isovolumetric myocardial acceleration (IVA) is load independent, reportedly predicts systolic functions, and correlates with exercise capacity in patients with reduced ejection fraction (EF). We hypothesized that IVA correlates with the pulmonary capillary wedge pressure (PCWP) in patients with reduced EF.
  
  
  RESULTS
  Of 113 patients, correlations between PCWP and IVA were done for all patients, 48 patients with EF ≥55%, and 65 patients with EF <55%. Results were compared to the correlation between PCWP and other echocardiographic predictors. IVA correlated moderately with PCWP in all patients (r=0.54, P<0.0001) and was comparable to the E/A and E/e' ratios. In patients with EF ≥55%, IVA lost correlation and the only predictor was the E/e' ratio (r=0.08, 0.58, P=0.58, <0.0001). In patients with EF <55%, IVA was better than E/A and E/e' (r=0.72, 0.61, 0.51, P<0.0001), especially for atrial fibrillation or when E/e' fell between 8 and 15. Furthermore, IVA >1.60 m/s(2) can predict PCWP ≥15 mmHg, with a sensitivity of 95%, specificity of 73%, and an area under the curve of 0.867 (P<0.0001).
  
  
  CONCLUSIONS
  IVA can predict PCWP in patients with reduced EF, and can be considered an alternative to the E/e' ratio for patients with atrial fibrillation or E/e' ratio between 8 and 15.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Alaa Mabrouk
authors.initials: AM
authors.lastname: Salem Omar
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tatsumi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Mana
authors.initials: M
authors.lastname: Hiraishi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tsuji
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kaneko
authors.forename: Keiko
authors.initials: K
authors.lastname: Ryo
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kawai
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology; D006328:Cardiac Catheterization; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007564:Japan; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D015588:Observer Variation; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left