title: A novel ultrasound predictor of pulmonary capillary wedge pressure assessed by the combination of left atrial volume and function: A speckle tracking echocardiography study.
abstract: 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 function (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=log10 (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.
authors.affiliation: Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan. Electronic address: masanori@ya2.so-net.ne.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawasaki
authors.affiliation: Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Ryuhei
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ono
authors.affiliation: Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Minatoguchi
authors.affiliation: Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Takatomo
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Iwama
authors.affiliation: Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hirose
authors.affiliation: Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Masazumi
authors.initials: M
authors.lastname: Arai
authors.affiliation: Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Noda
authors.affiliation: Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan.
authors.forename: Sachiro
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Medicine-Cardiology, Medical University of South Carolina and Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.affiliation: Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Minatoguchi
mesh_terms: D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D016014:Linear Models; D008297:Male; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology*
keywords: Atrial function; Atrial volume; Diastolic dysfunction; Pulmonary capillary wedge pressure; Speckle tracking echocardiography