The Correlation between Left Ventricular Filling Pressure and Fluid Responsiveness in Patients with Acute Heart Failure with Reduced Ejection Fraction

Background: Fluid responsiveness describes the capacity of the myocardium to raise stroke volume by at least 10% when ventricular filling is increased, consistent with the principle outlined by Frank and Starling. In patients with acute heart failure with reduced ejection fraction (HFrEF), elevated left ventricular filling pressure (LVFP) and impaired contractility frequently place the ventricle on the flattened segment of this relationship, resulting in a limited response to preload changes. Objectives: To investigate the relationship between LVFP and fluid responsiveness in patients with acute HFrEF. Methods: This study aimed to explore the link between LVFP and fluid responsiveness using echocardiography to track velocity–time integral (VTI) changes during a passive leg raising (PLR) maneuver. A cross-sectional observational design was applied, enrolling patients admitted with acute HFrEF from December 2024 to April 2025. LVFP was estimated through echocardiographic indices of E/A ratio, E/e' and calculated pulmonary capillary wedge pressure (PCWP). A ≥ 10% increase in VTI after PLR indicated fluid responsiveness. Results: Of 65 participants, 37 (57%) were non-responders. The non-responder group had higher LVFP values across all indices, namely: E/A, E/e', and PCWP. Fluid responsiveness correlated significantly with E velocity, E/A ratio, and E/e'. Conclusion: Higher LVFP is moderately associated with reduced fluid responsiveness in acute HFrEF, underscoring the value of echocardiographic indices in guiding individualized volume management.