Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure with and without mitral regurgitation

Abstract

These results indicate that, in patients with chronic heart failure due to dilated cardiomyopathy, pulmonary artery wedge pressure can be reliably estimated even when mitral regurgitation is present by combining Doppler echocardiographic variables of mitral and pulmonary venous flow.

Left atrial inflow propagation rate derived by transesophageal color M‐mode echocardiography is a promising index of preload

“…1 Although pulsed Doppler transthoracic echocardiography is useful for estimating PCWP, it is often technically inadequate in critically ill patients receiving mechanical ventilation. 2,3 However, transesophageal echocardiography (TEE) circumvents the limitations of transthoracic echocardiography in this setting.…”

Letter by Galderisi and Esposito Regarding Article, “Tissue Doppler Imaging in the Estimation of Intracardiac Filling Pressure in Decompensated Patients With Advanced Systolic Heart Failure”

“…The ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/Ea) has been reported to be unreliable for predicting LV diastolic pressures in patients with LV wall motion abnormalities related to left bundle-branch block and paced rhythm. 2 A second concern is that, if the relation between pulmonary capillary wedge pressure (PCWP) and the E/Ea ratio is insignificant, even the similar relationship between PCWP and E velocity deceleration time, well established previously, 3 is trivial. This finding can be at least partially explained by a trend toward the highest levels of PWCP occurring in the majority of patients with advanced heart failure: The narrower the PCWP dispersion, the lower the possibility of finding a significant relationship with both deceleration time and E/Ea ratio.…”

Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy

“…[2][3][4][5][6][7][8][9][10][11] Recently, Nishimura et al 13 reported that HCM patients present a particular challenge whereby conventional Doppler parameters (DT-E and E/A) are poorly predictive of filling pressures. Our findings further corroborate these observations.…”

“…Thus, a noninvasive method for determination of LV filling pressures in HCM is highly desirable. Although echocardiography has been successfully used to estimate filling pressures in a variety of cardiac disorders, [2][3][4][5][6][7][8][9][10][11] current methods are unreliable with normal systolic function, 12 particularly in HCM. 13 These results are related in part to the impaired relaxation-dominant influence on mitral inflow that overshadows the effects of increased filling pressures.…”