Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure.

ABSTRACT Background When left ventricular (LV) filling pressure (FP) increases, the mitral valve (MV) opens early and precedes tricuspid valve (TV) opening in early diastole. We hypothesized that a visually-assessed time sequence of atrioventricular valves opening could become a new marker of elevated LVFP. We thus tested the diagnostic ability of a novel echocardiographic scoring system, v isually-assessed time-difference between M V and T V opening (VMT) score, in heart failure (HF) patients. Methods We retrospectively analyzed 119 consecutive patients who underwent cardiac catheterization within 24 hours of echocardiography examination as a derivation cohort. In addition, a prospective study was conducted to validate the diagnostic ability of the VMT score in 50 patients. Elevated LVFP was defined as mean pulmonary arterial wedge pressure (PAWP) ≥15 mmHg. Time sequence of atrioventricular valves opening was visually assessed and scored (0, TV first; 1, simultaneous; 2, MV first). When the inferior vena cava was dilated, 1 point was added and VMT score was finally graded as 0–3. Cardiac events were recorded for 1 year after echocardiography. Results In the derivation cohort, PAWP was elevated in the higher VMT scores (0, 10±5; 1, 12±4; 2, 22±8; 3, 28±4 mmHg; ANOVA P Conclusions VMT scoring could be a novel additive marker of elevated LVFP and might also be associated with adverse outcomes in HF patients.