Echocardiographic Estimate of Pulmonary Capillary Wedge Pressure Improves Outcome Prediction in Heart Failure Patients With Reduced and Mildly Reduced Ejection Fraction - 23/05/25

Doi : 10.1016/j.echo.2025.04.005

Lorenzo Bazan, MD ^a, Francesco Gentile, MD ^a, Paolo Sciarrone, MD ^b, Francesco Buoncristiani, MD ^b, Giorgia Panichella, MD ^a, Simone Gasparini, MD ^a, Claudia Taddei, MSc ^b, Elisa Poggianti, MSc ^b, Iacopo Fabiani, MD, PhD ^b, Christina Petersen, MD ^b, Giuseppe Emanuele Lio, PhD ^c, Patrizio Lancellotti, MD, PhD ^d, Claudio Passino, MD ^a,^b, Michele Emdin, MD, PhD ^a,^b, Vladislav Chubuchny, MD ^b, Alberto Giannoni, MD, PhD ^a,^b,^⁎
^a Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy
^b Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
^c Department of Physics and European Laboratory for Non-linear Spectroscopy, University of Florence, Florence, Italy
^d Department of Cardiology, GIGA Cardiovascular, CHU of Liège, University of Liège, Liege, Belgium

^∗Reprint requests: Alberto Giannoni, MD, PhD, Cardiology and Cardiovascular Medicine Division, Fondazione G. Monasterio CNR-Regione Toscana, Via Giuseppe Moruzzi 1, Pisa 56124, Italy.Cardiology and Cardiovascular Medicine DivisionFondazione G. Monasterio CNR-Regione ToscanaVia Giuseppe Moruzzi 1Pisa56124Italy

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Abstract

Background

An echocardiographic algorithm to estimate pulmonary capillary wedge pressure (ePCWP) and pulmonary vascular resistance (ePVR) has been recently validated versus right heart catheterization.

Objective

To assess the prognostic significance of these measures in heart failure (HF) patients with reduced and mildly reduced ejection fraction.

Methods

Consecutive outpatients with HF and left ventricular ejection fraction (LVEF) <50% undergoing echocardiography were selected and followed up for the composite end point of all-cause death or HF hospitalization.

Results

Out of 2,214 patients (71 ± 12 years, 76% males, LVEF 35% ± 9%), ePCWP (16 ± 6 mm Hg) was elevated (>15 mm Hg) in 52% of cases and ePVR (1.7 ± 0.7 Wood units) was elevated (>2 Wood units) in 25% of cases. Patients with increased ePCWP were older and had a higher New York Heart Association class, more pronounced cardiac remodeling, systolic/diastolic dysfunction, and neurohormonal activation, particularly when ePVR was also elevated (P < .001). Over a median follow-up of 33 (17-48) months, both measures stratified patients for the risk of the primary end point (log-rank 151 for ePCWP and 60 for ePVR; P < .001). At adjusted regression analysis, ePCWP (hazard ratio for 1 mm Hg increase 1.03 [95% CI, 1.01-1.04]; P < .001) but not ePVR (P = .07) predicted the primary end point, even in patients with atrial fibrillation (P = .019), outperforming current diastolic dysfunction grading (P < .001) and both E/e’ and left atrial volume index (P < .001). The addition of ePCWP to a multivariable prognostic model improved the accuracy of risk prediction (P < .001).

Conclusion

The echocardiographic estimates of PCWP retained clinical and prognostic significance in a large contemporary cohort of patients with chronic HF and LVEF <50%.

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Central Illustration

A quantitative echocardiographic algorithm to estimate PCWP retains clinical and prognostic significance in HF patients with LVEF <50%, even in patients with AF, outperforming both E/e’ and LAVi and current diastolic dysfunction grading and improving the accuracy of risk prediction of a multivariable prognostic model.

Central Illustration :

Central IllustrationA quantitative echocardiographic algorithm to estimate PCWP retains clinical and prognostic significance in HF patients with LVEF <50%, even in patients with AF, outperforming both E/e’ and LAVi and current diastolic dysfunction grading and improving the accuracy of risk prediction of a multivariable prognostic model.

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Highlights

•	Elevated LV filling pressures correlate to clinical severity and outcomes in HF.
•	An echocardiographic algorithm to estimate PCWP and PVR has been recently validated.
•	ePCWP predicted all-cause death and HF hospitalization in HFrEF and HFmrEF patients.
•	ePCWP retained its prognostic efficacy even in patients with AF.
•	ePCWP outperformed current diastolic dysfunction grading in risk prediction.

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Keywords : Pulmonary capillary wedge pressure, Filling pressures, Echocardiography, Diastolic function, Chronic heart failure

Abbreviations : AF, CO, COPD, eGFR, ePCWP, ePVR, HF, HFmrEF, HFpEF, HFrEF, HR, ICD, IVCd, LAVi, LV, LVAD, LVEF, mPAP, NT-proBNP, NYHA, PCWP, PVR, RAP, RHC, RVFAC, SCD, sPAP, SV, TAPSE, WU

Plan

Introduction

Methods

Subjects and Study Design

Transthoracic Echocardiography

Follow-Up

Statistical Analysis

Results

Clinical Correlates of PCWP and PVR

	Drs. Bazan and Gentile contributed equally to this work.
	Drs. Chubuchny and Giannoni contributed equally to this work.
	Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.