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Assessment of left ventricular filling pressure with Doppler velocities across the patent foramen ovale

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Abstract

Background

The utility of Doppler velocities across the patent foramen ovale (PFO) to estimate left ventricular (LV) filling pressure is not well known.

Methods

The best cut-off value of peak interatrial septal velocity across a transeptal puncture site measured by transesophageal echocardiography for estimating high mean left atrial (LA) pressure (≥ 15 mmHg) was determined in 17 patients. This cut-off value was subsequently applied to 67 patients with a PFO undergoing transthoracic echocardiography (TTE) for assessing the value of PFO velocity in determining LV filling pressure.

Results

The peak systolic interatrial septal velocities significantly correlated with directly measured mean LA pressures during transcatheter mitral valve procedure (r = 0.77, P < 0.001). The best cut-off value was 1.7 m/s for predicting high LA pressure (AUC 0.91; sensitivity 90%, specificity 86%). When this cut-off was applied to patients undergoing TTE, peak PFO velocity ≥ 1.7 m/s correlated with reduced e′, higher E/e′, and higher tricuspid regurgitation velocity (P < 0.01). LV filling pressure according to the 2016 diastolic guideline was compared with peak PFO velocity in 51 patients. Among patients with high filling pressure according to the guidelines (n = 20), peak PFO velocity ≥ 1.7 m/s was present in 60% of patients. In patients with normal filling pressure per the guidelines (n = 31), PFO velocity < 1.7 m/s was present 84%. Sensitivity and specificity were 75% and 92%, respectively, in patients with sinus rhythm, but were only 50% and 57%, respectively, among patients with atrial fibrillation.

Conclusions

Doppler-derived peak PFO velocities could be valuable in the assessment of increased LV filling pressure using 1.7 m/s as the cut-off value.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA

    Saki Ito, Sumandeep Dhesi, William R. Miranda, Jeffrey B. Geske, Nandan S. Anavekar, Kareem Morant, Charanjit S. Rihal, Mackram F. Eleid & Jae K. Oh

  2. Department of Medicine, Faculty of Medicine, Division of Cardiology at the University of British Columbia, Vancouver, BC, Canada

    Sumandeep Dhesi

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  1. Saki Ito
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  2. Sumandeep Dhesi
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  8. Mackram F. Eleid
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Correspondence to William R. Miranda.

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Conflict of interest

Saki Ito, Sumandeep Dhesi, William R. Miranda, Jeffrey B. Geske, Nandan S. Anavekar, Kareem Morant, Charanjit S. Rihal, Mackram F. Eleid and Jae K. Oh declare that they have no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

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Ito, S., Dhesi, S., Miranda, W.R. et al. Assessment of left ventricular filling pressure with Doppler velocities across the patent foramen ovale. J Echocardiogr 19, 158–165 (2021). https://doi.org/10.1007/s12574-020-00509-2

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  • DOI: https://doi.org/10.1007/s12574-020-00509-2

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