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. 2021 Jun;35(6):1646-1653.
doi: 10.1053/j.jvca.2021.01.051. Epub 2021 Feb 2.

Tissue Doppler Imaging (E/e') and Pulmonary Capillary Wedge Pressure in Patients With Severe Aortic Stenosis

Yoko Kagemoto  1 , Renan A Ferrufino  2 , Jeffrey T Lyvers  3 , Jamel Ortoleva  2 , Andrew R Weintraub  4 , Natesa G Pandian  5 , James D Thomas  6 , Frederick C Cobey  7
Affiliations

Tissue Doppler Imaging (E/e') and Pulmonary Capillary Wedge Pressure in Patients With Severe Aortic Stenosis

Yoko Kagemoto et al. J Cardiothorac Vasc Anesth. 2021 Jun.

Abstract

Objective: Although American and European consensus statements advocate using the ratio of the transmitral E velocity and tissue Doppler early diastolic mitral annular velocity (E/e') in the assessment of left-sided heart filling pressures, recent reports have questioned the reliability of this ratio to predict left atrial pressures in a variety of disease states. The authors hypothesized that there is a clinically significant correlation between E/e' and pulmonary capillary wedge pressure (PCWP) in patients with severe aortic stenosis.

Design: Retrospective cohort study.

Participants: The study comprised 733 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve replacement for severe aortic stenosis.

Interventions: None.

Measurements and main results: PCWP and E/e'ave (average of the lateral and medial annulus tissue Doppler velocities) were measured with a pulmonary artery catheter and transthoracic echocardiography during preprocedural evaluation. Patients were grouped by left ventricular ejection fraction (LVEF) ≥50% and LVEF <50%. Spearman rank correlation, analysis of variance, and t and chi-square tests were used to analyze the data. Seventy-nine patients met the inclusion criteria. There was no significant correlation between E/e'ave and PCWP (n = 79, Spearman r = 0.096; p = 0.3994). This correlation did not improve when ventricular function was considered (LVEF <50%: n = 11, Spearman r = -0.097; p = 0.776 and LVEF ≥50%: n = 68, Spearman r = 0.116; p = 0.345). There was no statistically significant difference in mean PCWP between each range of E/e'ave.

Conclusion: A clinically relevant relationship between E/e' and PCWP was not observed in patients with severe aortic stenosis.

Keywords: E/e’; TAVR; aortic stenosis; diastology; echocardiography; pulmonary capillary wedge pressure; tissue Doppler; transcatheter aortic valve replacement.

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Conflict of interest statement

Conflict of Interest The authors have no conflict of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report.

Figures

Figure 1.
Figure 1.
Box-plot distribution of E/ e’ave in different LVEF groups.
Figure 2.
Figure 2.
Relationship between E/ e’ave and PCWP (With different plot color for LVEF ≥50% and LVEF <50%). The regression line on figure 2 represents the linear relationship between E/e’ average for the whole cohort There was no significant linear correlation between E/e’ave and PCWP. Correlation coefficient = 0.13 (p=0.27). The correlation did not improve when patients with depressed systolic ventricular function were studied independently from those with preserved ejection function. (1) EF ≥50% (n=68), correlation coefficient =0.09 (p=0.48), (2) EF<50% (n=11), correlation coefficient = 0.12 (p=0.73).
Figure 3.
Figure 3.
Distribution of PCWP in each E/ e’ave groups. There was no statistically significant difference in mean PCWP between each range of E/e’ave.
Figure 4.
Figure 4.
Relationship between E/e’ave and PCWP for the same procedure date group. The correlation between E/e’ave and PCWP in this group was still poor. (n=21, correlation coefficient = 0.21, p=0.35)
See this image and copyright information in PMC

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