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.
Observational (n=50)
Does mitral E/Ea or BNP better predict PCWP >15 mm Hg in intensive care patients?
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.
Effect estimate: r=0.69 (E/Ea) vs r=0.32 (BNP)
p-value: p=<0.001
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 (P15 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.
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.