Key result
Mitral E/Ea correlated better with pulmonary capillary wedge pressure than BNP (r=0.69 vs r=0.32) and provided higher specificity (88% vs 56%) for predicting PCWP >15 mm Hg in ICU patients.
Why the study?
Does mitral E/Ea or BNP better predict PCWP >15 mm Hg in intensive care patients?
Observational (n=50)
Does mitral E/Ea or BNP better predict PCWP >15 mm Hg in intensive care patients?
Effect estimate: r=0.69 (E/Ea) vs r=0.32 (BNP)
p-value: p=<0.001
In intensive care patients, mitral E/Ea correlates better with PCWP and is more specific than BNP for predicting elevated left ventricular filling pressures, particularly in those with cardiac disease.
May aid noninvasive filling pressure assessment in cardiac ICU patients; hypothesis-generating pending prospective validation.
BACKGROUND: Early transmitral velocity/tissue Doppler mitral annular early diastolic velocity (E/Ea) and B-type natriuretic peptide (BNP) have been correlated with left ventricular filling pressures, yet there are no data on how these 2 estimates of left ventricular filling pressures compare. METHODS AND RESULTS: Patients admitted to intensive care underwent simultaneous tissue Doppler echocardiography, BNP measurement, and pulmonary capillary wedge pressure (PCWP) determination. The ability of mitral E/Ea and BNP to predict PCWP >15 mm Hg was assessed. Fifty patients were studied. Ln BNP had a correlation of r=0.32 (P=0.02) with PCWP compared with r=0.69 (P<0.001) between E/Ea and PCWP. E/Ea >15 was the optimal cutoff to predict PCWP >15 mm Hg (sensitivity, 86%; specificity, 88%), whereas the optimal BNP cutoff was >300 pg/mL (sensitivity, 91%; specificity, 56%). The correlation between change in PCWP and change in E/Ea at 48 hours was r=0.87 (P=0.003) compared with r=-0.59 (P=0.39) for BNP. In the 36 patients with cardiac disease, E/Ea >15 (sensitivity, 92%; specificity, 91%) appeared more accurate than BNP >400 pg/mL (sensitivity, 92%; specificity, 51%), whereas in patients without cardiac disease, BNP (sensitivity, 81%; specificity, 83%) appeared more accurate than E/Ea >15 (sensitivity, 74%; specificity, 72%) for PCWP >15 mm Hg. CONCLUSIONS: In intensive care unit patients, mitral E/Ea has a better correlation than BNP with PCWP. Both BNP and mitral E/Ea have high sensitivity for PCWP >15 mm Hg; however, E/Ea appears more specific in this patient population. In patients without cardiac disease, BNP appears more accurate than E/Ea for PCWP >15 mm Hg, whereas E/Ea appears more accurate in patients with cardiac disease.
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Dokainish et al. (2004) conducted an observational in Intensive care unit patients (n=50). Mitral E/Ea vs. B-type natriuretic peptide (BNP) was evaluated on Correlation with pulmonary capillary wedge pressure (PCWP) and prediction of PCWP >15 mm Hg (r=0.69 (E/Ea) vs r=0.32 (BNP), p=<0.001). Mitral E/Ea correlated better with pulmonary capillary wedge pressure than BNP (r=0.69 vs r=0.32) and provided higher specificity (88% vs 56%) for predicting PCWP >15 mm Hg in ICU patients.
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