The MoliWP formula (0.35 x pTRG + 9 x E/DT) predicts PCWP non-invasively with AUC 0.960 and Pearson R=0.919, demonstrating high accuracy and strong correlation.
Does the novel MoliWP echocardiographic formula accurately estimate pulmonary capillary wedge pressure compared to invasive right heart catheterization in patients with heart failure or post-transplant?
The novel MoliWP echocardiographic formula provides a highly accurate, non-invasive estimation of pulmonary capillary wedge pressure using easily obtainable parameters.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Pulmonary capillary wedge pressure (PCWP) is crucial for assessing left ventricular filling pressures and guiding heart failure management. Traditionally measured invasively via right heart catheterization (RHC), its risks have driven interest in non-invasive echocardiographic alternatives. Despite several proposed formulas, limitations in accuracy or complexity persist, warranting improved predictive models. Purpose This study aimed to evaluate the correlation between invasively measured PCWP and echocardiographic parameters, assess the accuracy and correlation of existing non-invasive formulas, and derive a novel predictive model for PCWP estimation. Methods A prospective, single-center study was conducted on 72 patients undergoing RHC for heart failure, pulmonary arterial hypertension (PAH), and post-heart transplant follow-up. All participants underwent echocardiographic evaluation within 24 hours of RHC (30 minutes in the acute setting). Several established PCWP estimation formulas were analyzed in terms of accuracy and correlation with the collected data. Excluding patients with PAH, in whom pulmonary pressures do not reflect increased left-sided filling pressures, and those in whom the peak tricuspid regurgitation gradient (pTRG) could not be sampled, a novel model integrating pTRG and the E/DT ratio was derived in 47 patients (65% of the population) through forward stepwise linear regression. Results The proposed MoliWP formula (0.35 x pTRG + 9 x E/DT) demonstrated excellent predictive accuracy (AUC: 0.960, p0.001) and a strong correlation with invasive PCWP (Pearson R=0.919, p0.001) in the derivation cohort. Existing formulas showed varying accuracy and correlation depending on population characteristics. Echocardiography also strongly correlated with invasive hemodynamic parameters, including right atrial pressure (R=0.869), cardiac index (R=0.836), pulmonary vascular resistance (R=0.821), systolic pulmonary artery pressure (R=0.936), and mean pulmonary artery pressure (R=0.878), the latter derived from the mean gradient of tricuspid regurgitation. All findings were statistically significant (p0.001). Conclusions This pilot study introduces the MoliWP formula as a promising approach for non-invasive PCWP estimation, demonstrating strong correlation and high predictive accuracy within the derivation cohort. Its key strength lies in the use of easily obtainable parameters, making it accessible via standard transthoracic echocardiography. However, meticulous sampling and operator expertise remain crucial to avoid misestimations. External validation is required to confirm its broader applicability. Future research should focus on multicenter validation, assessment in acute and chronic settings, and integration with advanced imaging techniques and artificial intelligence to enhance non-invasive hemodynamic profiling.
Melis et al. (Sat,) reported a other. The MoliWP formula (0.35 x pTRG + 9 x E/DT) predicts PCWP non-invasively with AUC 0.960 and Pearson R=0.919, demonstrating high accuracy and strong correlation.