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 ASE 2016, ASE 2025, and 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, Setting, and Participants: Post hoc analysis of a prospective observational study conducted in a tertiary cardiac intensive care unit in London, United Kingdom.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.Conclusion: Echocardiographic algorithms demonstrated modest accuracy for detecting elevated PCWP in AMI-CS.PAC is required when precise measurement of filling pressures is required.