Echocardiographic Estimate of Pulmonary Capillary Wedge Pressure Improves Outcome Prediction in Heart Failure Patients With Reduced and Mildly Reduced Ejection Fraction.

Abstract

Background: An echocardiographic algorithm to estimate pulmonary capillary wedge pressure (ePCWP) and pulmonary vascular resistance (ePVR) has been recently validated versus right heart catheterization.

Objective: To assess the prognostic significance of these measures in heart failure (HF) patients with reduced and mildly reduced ejection fraction.

Methods: Consecutive outpatients with HF and left ventricular ejection fraction (LVEF) <50% undergoing echocardiography were selected and followed up for the composite end point of all-cause death or HF hospitalization.

Results: Out of 2,214 patients (71 ± 12 years, 76% males, LVEF 35% ± 9%), ePCWP (16 ± 6 mm Hg) was elevated (>15 mm Hg) in 52% of cases and ePVR (1.7 ± 0.7 Wood units) was elevated (>2 Wood units) in 25% of cases. Patients with increased ePCWP were older and had a higher New York Heart Association class, more pronounced cardiac remodeling, systolic/diastolic dysfunction, and neurohormonal activation, particularly when ePVR was also elevated (P < .001). Over a median follow-up of 33 (17-48) months, both measures stratified patients for the risk of the primary end point (log-rank 151 for ePCWP and 60 for ePVR; P < .001). At adjusted regression analysis, ePCWP (hazard ratio for 1 mm Hg increase 1.03 [95% CI, 1.01-1.04]; P < .001) but not ePVR (P = .07) predicted the primary end point, even in patients with atrial fibrillation (P = .019), outperforming current diastolic dysfunction grading (P < .001) and both E/e' and left atrial volume index (P < .001). The addition of ePCWP to a multivariable prognostic model improved the accuracy of risk prediction (P < .001).

Conclusion: The echocardiographic estimates of PCWP retained clinical and prognostic significance in a large contemporary cohort of patients with chronic HF and LVEF <50%.