Accuracy of Noninvasive Estimation of Pulmonary Wedge Pressure by Echocardiographic Indices in Heart Transplant Recipients

Background. Pulmonary capillary wedge pressure (PCWP) can be estimated from transmitral or color M-mode Doppler flow propagation velocities. However, it has been recommended to not use these indices in heart transplant recipients. Our aim was to compare the accuracy of color M-mode, Doppler, and Doppler tissue imaging (DTI)‐ derived indices to predict PCWP in heart transplant recipients. Methods. We studied 50 consecutive heart transplant recipients scheduled for routine right-sided heart catheterization and endomyocardial biopsy. Their mean age was 49 17 years and the mean time after heart transplantation was 29 41 months. An echocardiogram was performed immediately after the invasive procedure. We analysed PCWP, transmitral flow velocity variables (peak velocity during early filling (E) and deceleration time [DT]), color M-mode Doppler flow propagation velocity (Vp), and mitral annulus peak early diastolic velocity (E=) from DTI. Doppler estimated-PCWP (ePCWP) was calculated as follows: (5.27 E/Vp) 4.6. Results. Mean ejection fraction was 66 11%. The mean invasive measured PCWP was 11.14 5.4 mm Hg and the mean noninvasive ePCWP was 11.13 1.8 mm Hg (r 0.66; P .0001). A good correlation was present between invasive PCWP and mitral PW-Doppler and DTI parameters: peak E 91 22 cm/s (r 0.34; P .02) and DT 143 26 s (r 0.436; P .002), E/E= ratio medial mitral annulus 10 4 cm/s (r 0.353; P .026) and E/E= ratio lateral mitral annulus 6 2 cm/s (r 0.462; P .002). E/Vp was the most accurate index for predicting PCWP (r 0.615; P .0001). Conclusions. Compared with other indirect Doppler indices, E/Vp showed the best correlation to predict PCWP in heart transplant recipients. Despite previous recommendations, PCWP can be accurately estimated from color M-mode indices, giving useful information and avoiding the risks of invasive measurements.