Echocardiographic evaluation of left ventricular filling pressure in heart transplant recipients

Figures & data

Figure 1. Representative colour-coded TDI 4-chamber view of the left ventricle in which 5 × 10 mm regions of interest were placed at the insertion of the anterior and posterior mitral leaflets, respectively. Time-dependent annular tissue velocities are depicted on the right. Peak early mitral relaxation velocities, e’, (blue crosses) were measured in the septum and lateral free wall.

Table I. Population characteristics one year after heart transplantation.

Recipient characteristics	N = 83
Age in years	54 (21–67)
Male gender	65 (78)
Body mass index (kg/m^2)	26 ± 4
Ischaemic aetiology of heart failure	34 (41)
Systolic blood pressure (mm Hg)	142 ± 20
Diastolic blood pressure (mm Hg)	86 ± 11
Heart rate (beats per minute)	85 ± 12
Estimated GFR (ml/min/1.73 m^2)	65 ± 21
NT-proBNP (ng/l)	469 (218–763)
Medication
Calcineurin inhibitor	70 (84)
Everolimus	17 (21)
Mycophenolate	78 (94)
Prednisone	80 (96)
Beta blocker	24 (29)
ACEI/ARB	12 (14)
Calcium channel antagonist	15 (18)
Statin	78 (94)
Insulin	7 (8)
Oral antidiabetics	7 (8)
Diuretics	38 (46)
Donor characteristics
Age	41 ± 13
Male gender	47 (57)

Values are presented as mean ± SD, median (range) or number (%) as appropriate. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; GFR, glomerular filtration rate as estimated by the Modification of Diet in Renal Disease formula.

Table II. Key hemodynamic parameters one year after heart transplantation.

Variable	No of patients	Value
Echocardiography
LVIDd (cm)	83	5.0 ± 0.5
IVSd (cm)	83	1.0 ± 0.2
LVPWd (cm)	83	0.9 ± 0.1
LVEF (%)	83	56 ± 9
Left atrial area (cm²)	79	23 ± 6
Right atrial area (cm²)	77	18 ± 4
Cardiac output (l/min)	83	5.4 ± 1.3
TTPGmax (mmHg)	63	26 ± 8
E (m/s)	83	0.80 ± 0.22
E deceleration time (ms)	67	168 ± 43
e’septal (m/s)	82	0.06 ± 0.02
e’lateral (m/s)	81	0.08 ± 0.02
E/e’septal	82	15.0 ± 5.6
E/e’lateral	81	10.8 ± 4.2
E/e’average	81	12.3 ± 4.4
Right-sided heart catheterisation
Right atrial pressure in mmHg	82	3.5 (2–5)
Systolic pulmonary artery pressure in mmHg	83	28 (23–32)
Diastolic pulmonary artery pressure in mmHg	82	9 (7–12)
Mean pulmonary artery pressure in mmHg	83	18 (14–21)
PCWP in mmHg	83	9 (7–12)
Cardiac output (l/min)	83	5.9 ± 1.3
Pulmonary vascular resistance (dyn·s·cm^− 5)	83	109 (78–138)

Values are presented as mean ± standard deviation or median (interquartile range) unless otherwise stated.

IVSd, intra-ventricular septum thickness in end diastole; LVIDd, left ventricular internal diameter in end diastole; LVPWd, left ventricular posterior wall thickness in end diastole; TTPG_max, maximal transtricuspid pressure gradient; E, peak early mitral inflow velocity.

e’_septal and e’_lateral denote early myocardial relaxation velocity at the insertion of the mitral valve in the intraventricular septum and lateral left ventricular wall, respectively.

Figure 2. The relationship between invasively measured PCWP and (a) LVEF, (b) peak early mitral inflow velocity (E), (c) E deceleration time and (d) E divided by the septal early mitral relaxation velocity (E/e’_septal).

Table III. Echocardiographic predictors of PCWP.

Echocardiographic variable	r	p
LVEF	− 0.30	0.006
Cardiac output (estimated)	− 0.09	0.41
Early mitral inflow velocity (E)	0.45	< 0.001
Transtricuspid pressure gradient	0.19	0.15
E deceleration time	− 0.08	0.52
Septal mitral early relaxation velocity (e’septal)	− 0.14	0.22
Lateral mitral early relaxation velocity (e’lateral)	0.04	0.74
E/e’septal	0.47	< 0.001
E/e’lateral	0.36	0.001
E/e’average	0.43	< 0.001

Correlation between continuous echocardiographic variables and invasively measured pulmonary capillary wedge pressure one year after heart transplantation analysed by bivariate, linear regression.

Table IV. Independent predictors of PCWP.

Variable	Standardised β	p
E/e’septal	0.41	0.002
Maximum transtricuspid pressure gradient	0.18	0.15
LVEF	− 0.04	0.74
Gender (M = 1; F = 0)	0.00	0.98
Age	− 0.17	0.24
Systolic blood pressure	− 0.12	0.37
Estimated GFR	− 0.21	0.14

Multiple linear regression analysis with invasively measured PCWP as the dependent variable. r square for the entire model was 0.29.

E, peak early mitral inflow velocity; e’_septal, early myocardial relaxation velocity at the insertion of the mitral valve in the intra-ventricular septum.