Doppler echocardiography in advanced systolic heart failure: a reliable noninvasive alternative to Swan-Ganz catheter

Background: Although several studies have demonstrated a good correlation between Doppler echocardiographic and invasive measurements of single hemodynamic variables, the accuracy of echocardiography in providing a comprehensive assessment in individual patients has not been validated. To assess the accuracy and clinical applicability of Doppler echocardiography in determining the entire hemodynamic profile in stable patients with advanced systolic heart failure (HF). Methods and Results: Simultaneous Doppler echocardiography and Swan-Ganz catheterization were performed in 43 consecutive patients with advanced HF. Echocardiographic data required for estimation of right atrial, pulmonary artery systolic and pulmonary capillary wedge pressures (PCWP), and cardiac output and pulmonary vascular resistance (PVR) were obtained and compared with hemodynamic data. For all variables, invasive and noninvasive hemodynamic values were highly correlated (p<0.0001), with very low bias and narrow 95% confidence limits. In 16 patients with baseline elevated PVR (>3 Wood units) and PCWP (>20 mm Hg), hemodynamic and Doppler measurements were simultaneously repeated after unloading manipulations. Absolute values and changes of PVR and PCWP after unloading were still accurately predicted (r = 0.96 for PVR and r = 0.92 for PCWP, respectively). Conclusions: Doppler echocardiography may offer a valid alternative to invasive cardiac catheterization for the comprehensive hemodynamic assessment of patients with advanced HF, and may assist with monitoring and optimization of therapy in potential heart transplant recipients.