Key result
Non-invasive LVSP combining brachial BP and Doppler gradients correlates strongly with invasive measurements.
Why the study?
Because LVSP cannot be equated with brachial blood pressure in HOCM, calculating myocardial work requires exploring whether LVSP can be derived non-invasively by combining Doppler gradients and blood pressure.
Can left ventricular systolic peak pressure be accurately estimated non-invasively using Doppler gradients and blood pressure in patients with hypertrophic obstructive cardiomyopathy?
Observational (n=20)
Can left ventricular systolic peak pressure be accurately estimated non-invasively using Doppler gradients and blood pressure in patients with hypertrophic obstructive cardiomyopathy?
Effect estimate: r = 0.87
Absolute Event Rate: 190.9% vs 188.9%
p-value: p=<0.001
Non-invasive estimation of left ventricular systolic peak pressure in HOCM is feasible and correlates well with invasive measurements when combining brachial blood pressure with averaged mean and maximal Doppler gradients.
Supports non-invasive LVSP estimation in HOCM; leaves open prospective validation before clinical adoption.
AIMS: Myocardial work (MyW) is an echocardiographically derived parameter to estimate myocardial performance. The calculation of MyW utilizes pressure strain loops from global longitudinal strain and brachial blood pressure (BP) as a surrogate of left ventricular systolic pressure (LVSP). Since LVSP cannot be equated with BP in hypertrophic obstructive cardiomyopathy (HOCM), we explored whether LVSP can be derived non-invasively by combining Doppler gradients and BP. METHODS AND RESULTS: We studied 20 consecutive patients (8 women, 12 men; mean age 57.0 ± 13.9 years; NYHA 2.1 ± 0.8; maximal septal thickness 24.7 ± 6.3 mm) with indication for first alcohol septal ablation. All measurements were performed simultaneously in the catheterization laboratory (CathLab)-invasively: ascending aortic and LV pressures; non-invasively: BP, maximal (CWmax) and mean (CWmean) Doppler gradients.LVSP was 188.9 ± 38.5 mmHg. Mean gradients of both methods were comparable (CathLab 34.3 ± 13.4 mmHg vs. CW 31.0 ± 13.7 mmHg). Maximal gradient was higher in echocardiography (64.5 ± 28.8 mmHg) compared with CathLab (54.8 ± 24.0 mmHg; P < 0.05). Adding BP (143.1 ± 20.6 mmHg) to CWmax resulted in higher (207.7 ± 38.0 mmHg; P < 0.001), whereas adding BP to CWmean in lower (174.1 ± 26.1 mmHg; P < 0.01) derived LVSP compared with measured LVSP. However, adding BP to averaged CWmax and CWmean resulted in comparable results for measured and derived LVSP (190.9 ± 31.6 mmHg) yielding a favourable correlation (r = 0.87, P < 0.001) and a good level of agreement in the Bland-Altman plot. CONCLUSION: Non-invasive estimation of LVSP in HOCM is feasible by combining conventional BP and averaged CWmean and CWmax gradients. Hereby, a more reliable estimation of MyW in HOCM may be feasible.
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Batzner et al. (2023) conducted an observational in Hypertrophic obstructive cardiomyopathy (HOCM) (n=20). Non-invasive estimation of LVSP combining brachial BP and averaged CWmean and CWmax Doppler gradients vs. Invasive measurement of LVSP in the catheterization laboratory was evaluated on Left ventricular systolic pressure (LVSP) (r = 0.87, p=<0.001). Non-invasive estimation of left ventricular systolic pressure combining brachial blood pressure and averaged Doppler gradients correlated strongly with invasive measurements (r = 0.87, P < 0.001).
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