Distinct Doppler echocardiographic patterns of elevated left ventricular filling pressure in acute decompensated heart failure and AMI-related cardiogenic shock: a simultaneous Doppler–hemodynamic study

INTRODUCTION: Doppler echocardiography supports noninvasive hemodynamic assessment, but its interpretation may vary across acute heart failure syndromes. We compared Doppler filling patterns and their relationship with pulmonary capillary wedge pressure (PCWP) in acute decompensated heart failure (ADHF) and acute myocardial infarction-related cardiogenic shock (AMI-CS). MATERIAL AND METHODS: This single-center observational study included 61 patients with ADHF (n = 34) or AMI-CS (n = 27) who underwent contemporaneous echocardiographic and invasive hemodynamic assessment. Transmitral inflow, pulmonary venous flow, and tissue Doppler indices were compared between groups and analyzed in relation to PCWP. Exploratory ROC analyses assessed discrimination of PCWP ≥ 18 mmHg. RESULTS: Patients with ADHF had greater cardiac chamber enlargement and higher mean PCWP than those with AMI-CS (24.7 ± 8.4 vs. 18.0 ± 5.4 mmHg; p < 0.001). ADHF was characterized by higher E/A (2.8 ± 1.2 vs. 1.3 ± 1.2; p < 0.001), lower pulmonary venous S/D (0.7 ± 0.5 vs. 1.1 ± 0.5; p < 0.01), and higher average E/e' (21.0 ± 7.3 vs. 12.5 ± 4.7; p < 0.001). Deceleration time did not differ significantly. Average and septal E/e' correlated with PCWP in the pooled cohort but not within either group separately. Septal E/e' yielded AUCs of 0.868 (95% CI, 0.722-1.000) in ADHF and 0.762 (95% CI, 0.511-1.000) in AMI-CS. CONCLUSIONS: ADHF and AMI-CS exhibit distinct Doppler filling profiles alongside differences in invasive filling pressure and cardiac remodeling. These findings support contextual interpretation of Doppler indices during bedside hemodynamic assessment of critically ill patients. The diagnostic value of syndrome-specific interpretation requires independent validation.