• Joe-Elie Salem, Nadia Aissaoui, Lech Paluszkiewicz, Michiel Morshuis, Jan Gummert, Pascal Leprince, Jean-Yves Fagon, Jean Sébastien Hulot, and Benoit Diebold.
• 1Reanimation and Cardiology, AP-HP, Georges Pompidou European Hospital, Paris, France. 2INSERM UPMC UMRS 1166, ICAN, Université Pierre et Marie Curie, Paris, France. 3Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University of Bochum, Bad Oeynhausen, Germany. 4INSERM UMR-S 678, Laboratoire d'imagerie fonctionnelle, Université Pierre et Marie Curie, Paris, France. 5Faculty of Medicine, University Paris Descartes, Paris, France.
• Crit. Care Med.. 2014 Dec 1;42(12):2508-17.

ObjectivesWe investigated the impact of inodilators on the accuracy of E/e' ratio as a surrogate for pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure.SettingThe ratio of early diastolic transmitral flow velocity to tissue Doppler mitral annular early diastolic velocity, E/e', and pulmonary artery occlusion pressure have been shown to be correlated. The validity of E/e' for predicting pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure was recently challenged, but the influence of inodilators was not taken into account, despite the reported influence of these drugs on left ventricular relaxation properties.Patients And InterventionInvasive hemodynamic monitoring and echocardiographic data were collected prospectively from 39 patients with decompensated end-stage systolic heart failure (92% male), aged 56 ± 13 years. These patients had dilated ventricles with a low cardiac index (1.9 ± 0.6 L/min/m) and high pulmonary artery occlusion pressure (22 ± 8 mm Hg), and 90% required inodilator support during hospitalization.Measurements And Main ResultsThe correlation between septal E/e' and pulmonary artery occlusion pressure was good for examinations in the absence of inodilators (n = 21) (r = 0.7; p < 0.001), but no correlation was found when inodilators were used (n = 31). Lateral and mean E/e' were poorly correlated with pulmonary artery occlusion pressure, if at all, in both cases.ConclusionsBy modifying ventricular relaxation properties and the influence of filling pressure on e', inodilator agents severely impair the correlation between E/e' and pulmonary artery occlusion pressure in patients with decompensated end-stage systolic heart failure.

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