title: Noninvasive estimation of pulmonary capillary wedge pressure in patients with mitral regurgitation: A speckle tracking echocardiography study.
abstract: BACKGROUND
  Echocardiographic parameters to predict pulmonary capillary wedge pressure (PCWP) in mitral regurgitation (MR) are not yet elucidated. We reported that PCWP could be accurately estimated by novel KT index which is defined as log10[left atrial (LA) emptying function (EF)/LA volume]. We examined the usefulness of the KT index as a predictor of PCWP in primary and secondary MR with sinus rhythm and also MR with atrial fibrillation.
  
  
  METHODS
  LA dimension, strain, volume, EF, and E/e' were measured in moderate to severe MR with sinus rhythm (n=58, age: 67±8 years) and MR with atrial fibrillation (n=24, age: 69±11 years) just before catheterization and in normal subjects (n=26, age: 67±11 years) using speckle tracking echocardiography. MR with sinus rhythm was divided into primary MR (n=27) and secondary MR (n=31). The estimated PCWP (ePCWP) was calculated as 10.8-12.4×KT index.
  
  
  RESULTS
  There was a correlation between PCWP and LA dimension, E/e', minimum LA volume index, active LAEF, total LAEF, or LA strain (r=0.32, r=0.31, r=0.55, r=-0.61, r=-0.51, and r=-0.50, respectively, p<0.05). The better correlation was found between PCWP and ePCWP in MR including both primary and secondary MR and also MR with atrial fibrillation (r=0.70, r=0.67, and r=0.58, respectively, p<0.01). Multiple regression analysis revealed that ePCWP was an independent predictor of PCWP in MR. The ePCWP demonstrated good diagnostic accuracy (area under the curve of 0.86) and sensitivity (81%) and specificity (71%) to predict elevated PCWP >15mmHg using a cut-off of 16mmHg.
  
  
  CONCLUSIONS
  The ePCWP was the reliable echocardiographic parameter to predict PCWP in primary and secondary MR and might also be useful in MR with atrial fibrillation. The ePCWP may have an incremental value in a clinical setting.
authors.affiliation: Department of Cardiology, Gifu Heart Center, Gifu, Japan. Electronic address: yoshiakikawase@aoi.com.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawase
authors.affiliation: Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawasaki
authors.affiliation: Department of Cardiology, Gifu Heart Center, Gifu, Japan.
authors.forename: Ryuhei
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Cardiology, Gifu Heart Center, Gifu, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Nomura
authors.affiliation: Department of Cardiology, Gifu Heart Center, Gifu, Japan.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: Department of Cardiology, Gifu Heart Center, Gifu, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Ogawa
authors.affiliation: Department of Internal Medicine, Sawada Hospital, Gifu, Japan.
authors.forename: Hidemaro
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Gifu Heart Center, Gifu, Japan.
authors.forename: Taiji
authors.initials: T
authors.lastname: Miyake
authors.affiliation: Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tsunekawa
authors.affiliation: Department of Cardiology, Gifu Heart Center, Gifu, Japan.
authors.forename: Munenori
authors.initials: M
authors.lastname: Okubo
authors.affiliation: Department of Cardiology, Gifu Heart Center, Gifu, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsuchiya
authors.affiliation: Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tomita
authors.affiliation: Department of Cardiology, Gifu Heart Center, Gifu, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuo
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; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology; D016279:Atrial Function, Left; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012044:Regression Analysis; D012680:Sensitivity and Specificity
keywords: Echocardiographic parameter; Mitral regurgitation; Noninvasive estimation; Pulmonary capillary wedge pressure