title: Impact of inodilator drugs on echocardiographic assessments of left ventricular filling pressure in patients with decompensated end-stage heart failure*.
abstract: OBJECTIVE
  We investigated the impact of inodilators on the accuracy of E/e' ratio as a surrogate for pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure.
  
  
  METHODS
  The ratio of early diastolic transmitral flow velocity to tissue Doppler mitral annular early diastolic velocity, E/e', and pulmonary artery occlusion pressure have been shown to be correlated. The validity of E/e' for predicting pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure was recently challenged, but the influence of inodilators was not taken into account, despite the reported influence of these drugs on left ventricular relaxation properties.
  
  
  METHODS
  Invasive hemodynamic monitoring and echocardiographic data were collected prospectively from 39 patients with decompensated end-stage systolic heart failure (92% male), aged 56 ± 13 years. These patients had dilated ventricles with a low cardiac index (1.9 ± 0.6 L/min/m) and high pulmonary artery occlusion pressure (22 ± 8 mm Hg), and 90% required inodilator support during hospitalization.
  
  
  RESULTS
  The correlation between septal E/e' and pulmonary artery occlusion pressure was good for examinations in the absence of inodilators (n = 21) (r = 0.7; p < 0.001), but no correlation was found when inodilators were used (n = 31). Lateral and mean E/e' were poorly correlated with pulmonary artery occlusion pressure, if at all, in both cases.
  
  
  CONCLUSIONS
  By modifying ventricular relaxation properties and the influence of filling pressure on e', inodilator agents severely impair the correlation between E/e' and pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure.
authors.affiliation: 1Reanimation and Cardiology, AP-HP, Georges Pompidou European Hospital, Paris, France. 2INSERM UPMC UMRS 1166, ICAN, Université Pierre et Marie Curie, Paris, France. 3Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University of Bochum, Bad Oeynhausen, Germany. 4INSERM UMR-S 678, Laboratoire d'imagerie fonctionnelle, Université Pierre et Marie Curie, Paris, France. 5Faculty of Medicine, University Paris Descartes, Paris, France.
authors.forename: Joe-Elie
authors.initials: JE
authors.lastname: Salem
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
authors.forename: Lech
authors.initials: L
authors.lastname: Paluszkiewicz
authors.forename: Michiel
authors.initials: M
authors.lastname: Morshuis
authors.forename: Jan
authors.initials: J
authors.lastname: Gummert
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Fagon
authors.forename: Jean Sébastien
authors.initials: JS
authors.lastname: Hulot
authors.forename: Benoit
authors.initials: B
authors.lastname: Diebold
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D002317:Cardiovascular Agents / Q000494:pharmacology*; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure
chemical_list: D002317:Cardiovascular Agents