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Although the echocardiographic effective orifice area (EOA) calculated using the continuity equation is widely used for the assessment of severity in aortic stenosis (AS), the existence of high flow velocity at the left ventricular outflow tract (LVOT) potentially causes its overestimation. The proximal isovelocity surface area (PISA) method could be an alternative tool for the estimation of EOA that limits the influence of upstream flow velocity. EOA was calculated using the continuity equation (EOA Cont ) and PISA method (EOA PISA ), respectively, in 114 patients with at least moderate AS. The geometric orifice area (GOA) was also measured using the planimetry method in 51 patients who also underwent three-dimensional transesophageal echocardiography. Patients were divided into two groups according to the median LVOT flow velocity. EOA PISA could be obtained in 108 of the 114 patients (95%). Although there was a strong correlation between EOA Cont and EOA PISA (r = 0.78, P < 0.001), EOA Cont was statistically significantly larger than EOA PISA (0.86 ± 0.33 vs 0.75 ± 0.29 cm 2 , P < 0.001). Both EOA Cont and EOA PISA similarly correlated with GOA (r = 0.70, P < 0.001 and r = 0.77, P < 0.001, respectively). However, a fixed bias, which is hydrodynamically supposed to exist between EOA and GOA, was not observed between EOA Cont and GOA. In contrast, there was a negative fixed bias between EOA PISA and GOA with smaller EOA PISA than GOA. The difference between EOA Cont and GOA was significantly greater with a larger EOA Cont relative to GOA in patients with high LVOT flow velocity than in those without (0.16 ± 0.25 vs - 0.07 ± 0.10 cm 2 , P < 0.001). In contrast, the difference between EOA PISA and GOA was consistent regardless of the LVOT flow velocity (- 0.07 ± 0.12 vs - 0.07 ± 0.15 cm 2 , P = 0.936). The PISA method was applied to estimate EOA in patients with AS. EOA PISA could be an alternative parameter for AS severity grading in patients with high LVOT flow velocity in whom EOA Cont would potentially overestimate the orifice area., (© 2021. Springer Japan KK, part of Springer Nature.)

Purpose: We recently reported a noninvasive method for the assessment of right ventricular (RV) operating stiffness that is obtained by dividing the atrial-systolic descent of the pulmonary artery-RV pressure gradient (PRPGD AC ) derived from the pulmonary regurgitant velocity by the tricuspid annular plane movement during atrial contraction (TAPM AC ). Here, we investigated whether this parameter of RV operating stiffness, PRPGD AC /TAPM AC , is useful for predicting the prognosis of patients with heart failure (HF)., Methods: We retrospectively included 127 hospitalized patients with HF who underwent an echocardiographic examination immediately pre-discharge. The PRPGD AC /TAPM AC was measured in addition to standard echocardiographic parameters. Patients were followed until 2 years post-discharge. The endpoint was the composite of cardiac death, readmission for acute decompensation, and increased diuretic dose due to worsening HF., Results: 58 patients (46%) experienced the endpoint during follow-up. Univariable and multivariable Cox regression analyses demonstrated that the PRPGD AC /TAPM AC was associated with the endpoint. In a Kaplan-Meier analysis, the event rate of the greater PRPGD AC /TAPM AC group was significantly higher than that of the lesser PRPGD AC /TAPM AC group. In a sequential Cox analysis for predicting the endpoint's occurrence, the addition of PRPGD AC /TAPM AC to the model including age, sex, NYHA functional classification, brain natriuretic peptide level, and several echocardiographic parameters including tricuspid annular plane systolic excursion significantly improved the predictive power for prognosis., Conclusion: A completely noninvasive index of RV operating stiffness, PRPGD AC /TAPM AC , was useful for predicting prognoses in patients with HF, and it showed an incremental prognostic value over RV systolic function., (© 2021. Springer Japan KK, part of Springer Nature.)

Background: A v wave on pulmonary artery wedge (PAW) pressure sometimes augments and appears on pulmonary artery (PA) pressure wave in patients with heart failure (HF). However, the significance of PA v wave in HF remains to be elucidated., Methods: We retrospectively analyzed pressure waveforms in 61 HF patients (left ventricular ejection fraction 35 ± 15%). On the PAW and PA pressure waveforms, mean pressure as well as peak and amplitude of v waves (ampPAWv and ampPAv, respectively) were measured. Occurrence of worsening HF and cardiac death was recorded for 2 years after the catheterization., Results: The ampPAWv did not correlate with ampPAv. When the patients were divided into 4 groups: I (high-ampPAWv/high-ampPAv), II (high-ampPAWv/low-ampPAv), III (low-ampPAWv/high-ampPAv), and IV (low-ampPAWv/low-ampPAv), the prevalence of group III was low (I: 13, II: 17, III: 4, IV: 27). Mean pressures of PAW and PA were similarly elevated in groups I and II. Cardiac index was lowest (I: 2.0 ± 0.4, II: 2.8 ± 0.6, III: 2.2 ± 0.2, IV: 2.4 ± 0.6 L/min/m 2 , ANOVA P < 0.01, P < 0.01 for I vs II) and tricuspid annular plane systolic excursion / systolic PA pressure was impaired (I: 0.27 ± 0.07, II: 0.48 ± 0.22, III: 0.59 ± 0.35, IV: 0.68 ± 0.35 mm/mmHg, ANOVA P < 0.01) in group I. During the follow-up, 13 events were observed. Kaplan-Meier analysis showed that patients in group I were at highest risk of cardiac events., Conclusions: PA v was observed mainly in patients with augmented PAW v wave and decreased cardiac index, suggesting an advanced stage of HF. Moreover, augmented PAv was associated with worse outcome in HF patients.