Echocardiographic evaluation of hemodynamics in patients with decompensated systolic heart failure

Circ Cardiovasc Imaging. 2011 May;4(3):220-7. doi: 10.1161/CIRCIMAGING.111.963496. Epub 2011 Mar 11.


Background: Doppler echocardiography is currently applied for the assessment of left ventricular and right ventricular hemodynamics in patients with cardiovascular disease. However, there are conflicting reports about its accuracy in patients with unstable decompensated heart failure. The objective of this study was to evaluate the accuracy of the technique in patients with unstable heart failure.

Methods and results: Consecutive patients with decompensated heart failure had simultaneous assessment of left ventricular and right ventricular hemodynamics invasively and by Doppler echocardiography. In 79 patients, the noninvasive measurements of stroke volume (r=0.83, P<0.001), pulmonary artery systolic (r=0.83, P<0.001) and diastolic pressure (r=0.51, P=0.009), and mean right atrial pressure (r=0.85, P<0.001) all had significant correlations with invasively acquired measurements. Several Doppler indices had good accuracy in identifying patients with pulmonary capillary wedge pressure >15 mm Hg (area under the curve, 0.86 to 0.92). The recent American Society of Echocardiography/European Association of Echocardiography guidelines were highly accurate (sensitivity, 98%; specificity, 91%) in identifying patients with increased wedge pressure. In 12 repeat studies, Doppler echocardiography readily detected the changes in mean wedge pressure (r=0.75, P=0.005) as well as changes in pulmonary artery systolic pressure and mean right atrial pressure.

Conclusions: Doppler echocardiography provides reliable assessment of right and left ventricular hemodynamics in patients with decompensated heart failure.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Flow Velocity
  • Blood Pressure
  • Cardiac Catheterization
  • Cardiac Output
  • Cardiac Volume
  • Echocardiography, Doppler*
  • Female
  • Heart Failure, Systolic / diagnostic imaging
  • Heart Failure, Systolic / physiopathology*
  • Hemodynamics*
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Wedge Pressure
  • Sensitivity and Specificity
  • Stroke Volume
  • Ventricular Function*
  • Young Adult