Echocardiography for Estimating Filling Pressures in Ischemic Cardiogenic Shock: A Real-World Comparison of New Guidelines and Invasive Measurements.

OBJECTIVE

To compare the diagnostic performance of echocardiographic algorithms from the American Society of Echocardiography (ASE) 2016, ASE 2025, and British Society of Echocardiography (BSE) 2024 guidelines for elevated left ventricular filling pressures against pulmonary artery catheter (PAC)-measured pulmonary capillary wedge pressure (PCWP) in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS).

DESIGN AND

SETTING

Post hoc analysis of a prospective observational study conducted in a tertiary cardiac intensive care unit in London, United Kingdom.

PARTICIPANTS

Forty patients with AMI-CS who underwent simultaneous transthoracic echocardiography and PAC monitoring were included.

INTERVENTIONS: Echocardiographic classification of filling pressure was performed using ASE 2016, ASE 2025, and BSE 2024 guideline algorithms and compared against simultaneously obtained PAC measurements.

MEASUREMENTS AND MAIN

RESULTS

Elevated PCWP was defined as >15 mmHg. Diagnostic accuracy was 63% for ASE 2016, 64% for BSE 2024, and 73% for ASE 2025.

CONCLUSIONS

Echocardiographic algorithms demonstrated modest accuracy for detecting elevated PCWP in AMI-CS. PAC use is required when precise measurement of filling pressures is necessary.