# Echocardiographic estimation of left ventricular filling pressures in heart transplant recipients

## TL;DR

This study evaluates how well echocardiography can estimate left ventricular filling pressure in heart transplant patients, finding that certain measurements are strong predictors but not fully reliable.

## Contribution

The study identifies optimal echocardiographic cutoffs and models for estimating left ventricular filling pressure in heart transplant recipients.

## Key findings

- Lateral E/e′ showed the strongest correlation with left ventricular end-diastolic pressure (LVEDP).
- An average E/e′ cutoff of ≥6.8 predicted LVEDP ≥20 mmHg with high sensitivity.
- Echocardiographic parameters remain less reliable than invasive measurements for LVEDP in transplant recipients.

## Abstract

Echocardiographic estimation of left ventricular filling pressure in heart transplant (HTx) recipients is challenging. The ability of echocardiography to detect elevated left ventricular end-diastolic pressure (LVEDP) in HTx patients was assessed in this study.

This descriptive cross-sectional study included 39 HTx recipients who were candidates for endomyocardial biopsy as a part of their routine post-transplantation surveillance. Doppler transthoracic echocardiography was done before the procedure, and left heart catheterization was done during the endomyocardial biopsy. Thirty-nine patients (15 female, 24 male), with a mean age of 39.6 years (range 13–70), were enrolled. A strong relation was observed between lateral E/e′ and LVEDP (R = 0.64, P value < 0.001) and average E/e′ and LVEDP (R = 0.6, P value < 0.001). The best cutoff value for LVEDP prediction was the average E/e′ ≥ 6.8 with a sensitivity of 96.15% and specificity of 68.5% for the prediction of LVEDP more than or equal to 20 mmHg. Two predictive models comprising age, gender, and lateral E/e′ or average E/e′ were also proposed. A significant relationship was also found between LVEDP and left ventricular global longitudinal strain (R = − 0.31, P value < 0.01).

Lateral E/e′ was the best predictor of LVEDP. The cutoff of average E/e′ had the best validity for the estimation of LVEDP. Despite the strong observed association, echocardiographic parameters cannot be considered a surrogate for invasive LVEDP measurements when seeking information about left ventricle filling pressure on heart transplant recipients.