A multiparametric model involving invasive and non-invasive data to calculate left ventricular filling pressure in patients with HFrEF
A Ntalianis, G Velissaris, K Bratis, M Pentaris, I Dena, P Nastatos, N Biagkis, Z Morou, S Mykoniati, E Panagiotopoulos, M Zagkli, S Tomaras, N Papaioannou, D Chatzis, S PapaioannouAbstract
Background
Non-invasive estimation of the left ventricular filling pressure for risk stratification and therapy tailoring is a challenge in patients with HFrEF.
Purpose
To evaluate a multiparametric model combining invasive and non invasive data to accurately determine the left ventricular filling pressure in patients with HFrEF.
Methods
Consecutive HFrEF patients were prospectively recruited. All the patients were submitted to cardiac magnetic resonance imaging (MRI) and right heart catheterization. A mathematical model of forward stepwise regression analysis implementing 15 imaging and right heart catheterization parameters and corrected for age was used to create an algorithm for the calculation of the pulmonary capillary wedge pressure (PCWP). The left ventricular compliance (LVC) was derived from the formula: 0.9 x Systolic Arterial Pressure/Left ventricular end systolic volume.
Results
40 symptomatic HFrEF patients (ΝΥΗΑ 2.8±0.8, mean ejection fraction of 29±10%) and mean PCWP of 12±7 mmHg) were included. The mean right atrial pressure (RAP), LVC and left atrial volume index (LAVI) were found to associate with PCWP. The final formula to predict PCWP was defined as following: PCWP=(-2.55+1.33xRAP)+(2.96xLVC)+(0.07xLAVI). (table)
Conclusions
Invasive and non-invasive parameters derived from cardiac MRI and right heart catheterization can reliably predict the left ventricular filling pressure.For image description, please refer to the figure legend and surrounding text.