Validation of an echo-Doppler decision model to predict left ventricular filling pressure in patients with heart failure independently of ejection fraction

Frank Lloyd Dini, Piercarlo Ballo, Luigi Badano, Paolo Barbier, Piersilvio Chella, Umberto Conti, Salvatore Mario De tommasi, Maurizio Galderisi, Stefano Ghio, Enrico Magagnini, Andrea Pieroni, Andrea Rossi, Cesare Rusconi, Pier Luigi Temporelli

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article numberjeq047
Pages (from-to)703-710
Number of pages8
JournalChinese Journal of International Politics
Volume11
Issue number8
Publication statusPublished - Apr 17 2010

Keywords

  • Diastole
  • Echocardiography
  • Heart failure

ASJC Scopus subject areas

  • Political Science and International Relations

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