Noninvasive assessment of disproportionate right to left ventricular filling pressure in patients with heart failure.

Disproportionate right and left ventricular filling pressures, as measured using right atrial to wedge pressure (RA/WP) is a marker of right heart failure and worse outcomes in patients with heart failure (HF), but an invasive hemodynamic study is needed to measure RA/WP. Using echocardiography, an estimation of RA/WP (eRA/WP) could be calculated non-invasively. The aim of the present study was to understand the feasibility and usefulness of eRA/WP in the general HF population where invasive assessment is not routinely done. Estimated RA/WP was calculated using mitral E velocity, lateral and septal tissue Doppler velocities and inferior vena cava diameter. A second dataset obtained from patients undergoing cardiac catheterization was used to determine agreement between eRA/WP and catheter-derived RA/WP. Estimated RA/WP showed significant correlations with right atrial area (r = 0.27,p < 0.001), right ventricular diameter (r = 0.20,p = 0.006), right ventricular fractional area change (r=-0.19,p = 0.01) and systolic pulmonary artery pressure (r = 0.44,p < 0.001). Being in the highest quartile was significantly associated with the primary composite endpoint at 180 days in unadjusted (OR:2.28,95%CI:1.20-4.36,p = 0.012) and adjusted (OR:2.59,95%CI:1.26-5.31, p = 0.009) models. Intraclass correlation coefficients for agreement between eRA/WP and catheter-based RA/WP was 0.72 for single measures and 0.84 for average measures. Assessment of disproportionate right to left ventricular filling pressures using echocardiographic estimation of RA/WP is feasible and useful to predict short-term prognosis in HF patients.