Key result
Bedside estimation of left atrial pressure using central systolic blood pressure and peak LV-LA gradient correlated well with wedge pressure (r2 = 0.774, P < 0.0001).
Why the study?
Distinguishing cardiac from noncardiac causes of dyspnea is clinically important, creating a need for a reliable noninvasive measure of left atrial pressure.
Does noninvasive estimation of left atrial pressure using central systolic BP and echocardiographic peak LV-LA gradient correlate with invasive wedge pressure in stable patients?
Observational (n=75)
Does noninvasive estimation of left atrial pressure using central systolic BP and echocardiographic peak LV-LA gradient correlate with invasive wedge pressure in stable patients?
A novel noninvasive technique using central systolic blood pressure and echocardiography provides reliable estimates of left atrial pressure that correlate well with invasive wedge pressure.
May support bedside left atrial pressure estimation; hypothesis-generating and requires prospective validation before practice change.
Background Distinguishing cardiac from noncardiac causes of dyspnea is clinically important, and a reliable noninvasive measure of left atrial pressure (LAP) is needed. Subtracting the peak systolic gradient between left ventricle (LV) and left atrium (LA) from the central systolic blood pressure (BP) should provide this measure. Using a commercially available blood pressure system incorporating applanation tonometry and bedside echocardiography, we tested this hypothesis in a broad spectrum of patients. Methods A total of 75 stable patients, scheduled for right heart catheterization for any reason, were included. Central systolic pressure was measured by a Sphygmocor® tonometry system; peak LV‐LA gradient was calculated as 4*(peak mitral regurgitation (MR) velocity)2. Microbubble contrast was used as needed to augment the MR signal. LAP estimates using central BP were compared with wedge pressure as were LAP estimates using brachial BP. Results Left atrial pressure estimates using central BP showed a good correlation with wedge pressure (r2 = 0.774, P < .0001) while estimates using brachial systolic BP did not (r2 = 0.157, P = .0006). Using central BP, correlations between LAP and wedge were similar among groups with varying degrees of MR and normal vs reduced ejection fraction. Conclusions The use of central systolic BP and peak LV‐LA gradient by bedside echocardiography holds promise as a noninvasive measure of LAP. Our results are similar to those provided using current guidelines for echocardiographic estimation of LAP. Increased precision in the measurement of LV‐LA gradient would improve the accuracy of this new technique.
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Pressman et al. (2019) conducted an observational in Scheduled for right heart catheterization (n=75). Estimation of left atrial pressure using central systolic BP and peak LV-LA gradient vs. Wedge pressure and LAP estimates using brachial BP was evaluated on Correlation between LAP estimates using central BP and wedge pressure (r2 = 0.774, p=< .0001). Bedside estimation of left atrial pressure using central systolic blood pressure and peak LV-LA gradient correlated well with wedge pressure (r2 = 0.774, P < 0.0001).
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