TY - JOUR
T1 - Validation of an echo-Doppler decision model to predict left ventricular filling pressure in patients with heart failure independently of ejection fraction
AU - Dini, Frank Lloyd
AU - Ballo, Piercarlo
AU - Badano, Luigi
AU - Barbier, Paolo
AU - Chella, Piersilvio
AU - Conti, Umberto
AU - De Tommasi, Salvatore Mario
AU - Galderisi, Maurizio
AU - Ghio, Stefano
AU - Magagnini, Enrico
AU - Pieroni, Andrea
AU - Rossi, Andrea
AU - Rusconi, Cesare
AU - Temporelli, Pier Luigi
PY - 2010/9
Y1 - 2010/9
N2 - Aims: To test a decision model for non-invasive estimation of left ventricular filling pressure (LVFP) in patients with left ventricular (LV) dysfunction and a wide range of ejection fractions (EF).Methods and results: In patients with LV dysfunction (n = 270; EF = 42 ± 16), classification and regression tree (CART) analysis was used to generate a model for the prediction of elevated LVFP, defined as pulmonary capillary wedge pressure (PCWP) >15 mmHg, in a derivation cohort (n = 178). At each step of the decision tree, nodes including single or multiple criteria connected by Boolean operators were tested to achieve the best information entropy gain. Averaged mitral-to-myocardial early velocities ratio (E/e′) ≥13 OR E-wave deceleration time 15 mmHg needed the following criteria to be satisfied: (i) intermediate E/e′ (13 > E/e′ > 8); (ii) left atrial volume index >40 mL/m2 OR ratio of mitral E-wave and colour M-mode propagation velocity >2 OR difference in duration of pulmonary vein and mitral flow at atrial contraction >30 ms; (iii) estimated pulmonary artery systolic pressure >35 mmHg. Patients were correctly allocated according to PCWP with an 87 sensitivity and a 90 specificity. Compared with the best single parameter estimating LVFP, a 17 relative increase in accuracy was achieved in patients with EF >50. The model was prospectively validated in a testing group (n = 92): 80 sensitivity, 78 specificity.Conclusion: This sequential testing is useful to non-invasively predict LVFP in patients with LV dysfunction, especially in those with preserved EF.
AB - Aims: To test a decision model for non-invasive estimation of left ventricular filling pressure (LVFP) in patients with left ventricular (LV) dysfunction and a wide range of ejection fractions (EF).Methods and results: In patients with LV dysfunction (n = 270; EF = 42 ± 16), classification and regression tree (CART) analysis was used to generate a model for the prediction of elevated LVFP, defined as pulmonary capillary wedge pressure (PCWP) >15 mmHg, in a derivation cohort (n = 178). At each step of the decision tree, nodes including single or multiple criteria connected by Boolean operators were tested to achieve the best information entropy gain. Averaged mitral-to-myocardial early velocities ratio (E/e′) ≥13 OR E-wave deceleration time 15 mmHg needed the following criteria to be satisfied: (i) intermediate E/e′ (13 > E/e′ > 8); (ii) left atrial volume index >40 mL/m2 OR ratio of mitral E-wave and colour M-mode propagation velocity >2 OR difference in duration of pulmonary vein and mitral flow at atrial contraction >30 ms; (iii) estimated pulmonary artery systolic pressure >35 mmHg. Patients were correctly allocated according to PCWP with an 87 sensitivity and a 90 specificity. Compared with the best single parameter estimating LVFP, a 17 relative increase in accuracy was achieved in patients with EF >50. The model was prospectively validated in a testing group (n = 92): 80 sensitivity, 78 specificity.Conclusion: This sequential testing is useful to non-invasively predict LVFP in patients with LV dysfunction, especially in those with preserved EF.
KW - Diastole
KW - Echocardiography
KW - Heart failure
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U2 - 10.1093/ejechocard/jeq047
DO - 10.1093/ejechocard/jeq047
M3 - Article
C2 - 20400763
VL - 11
SP - 703
EP - 710
JO - European Journal of Echocardiography
JF - European Journal of Echocardiography
SN - 1525-2167
IS - 8
ER -