Estimating Pulmonary Capillary Wedge Pressures Using Doppler Variables of Early Diastolic Left Ventricular Inflow

Abstract

ulmonary capillary wedge pressure (PCWP) is an important clinical marker of cardiac function, 1-3 but measuring it requires right heart catheterization, which limits longterm monitoring or its use as a screening test. Therefore, a simple, reliable, and noninvasive method of estimating PCWP is required.Previous experimental studies have shown that left atrial pressure (LAP) is the most effective component of the transmitral flow velocity profile (TMF) obtained by pulsed Doppler echocardiography, 4-9 and there have been numerous investigations of the relationship between Doppler variables, including the early diastolic transmitral flow peak velocities (E), the late diastolic transmitral flow peak velocities (A), the ratio E to A (E/A), the deceleration time of E (DT) and the isovolumic relaxation time (IVRT), and PCWP or left ventricular end-diastolic pressure (LVEDP). 12-15 Some clinical studies have pointed out, however, that TMF cannot be used in all types of patients to estimate PCWP, because the relationship between PCWP and Doppler variables varies with the subject. 16,17 Other studies have also suggested that the LAP can be estimated more accurately using combinations of Doppler variables [18][19][20][21][22][23][24][25] ; for example, it has recently been shown that the propagation velocity (PV) of early diastolic left ventricular (LV) inflow based on color Doppler M-mode measurements was found to correlate well with the time constant of isovolumic LV relaxation (tau), and may be used to evaluate LV relaxation. 27,28,30,32 On the basis that Japanese Circulation Journal Vol.65, January 2001 E depends on LAP and LV relaxation, 9-11 the ratio of E and PV (E/PV) has been shown to correlate well with PCWP. [23][24][25] However, we considered that PCWP might correlate well with multilinear regression analysis using E and PV in the interpretation of the determinant component of E. Accordingly, the present study was designed to evaluate whether a multilinear regression model based on E and PV can estimate PCWP more accurately than other Dopplerbased methods in various cardiac disease states. Methods Study ProtocolIn the initial study group, Doppler echocardiography and cardiac catheterization were performed simultaneously, and an equation to estimate PCWP was obtained by multilinear regression analysis using E and PV. The reliability of the obtained equation was then tested prospectively in a second population (test population). In this second study, the patients were classified into 3 groups based on LV function and morphology: (1) LV systolic dysfunction, (2) LV hypertrophy, and (3) no evidence of LV systolic dysfunction or hypertrophy. We determined the correlations between PCWP and Doppler TMF variables, and between the estimated PCWP obtained from the regression equation and the PCWP measured using a Swan-Ganz catheter. All patients gave written informed consent before participation. Initial Study GroupThe initial group comprised 30 patients (21 men, 9 women) whose ages ranged from 35 to 80 years (mean, 57±19...

Doppler‐Derived Indexes and B‐Type Natriuretic Peptide in Prediction of Paroxysmal Atrial Fibrillation in Essential Hypertension: A Prospective Study

“…LV mass was calculated according to Devereux et al 18 and then divided by the body surface area to obtain the LVM index 19 . Based on previous studies, 18,20 the cutoff value for left ventricular hypertrophy (LVH) was defined as 134 and 110 g/m 2 in males and females, respectively.…”

“…The peak systolic velocity (V s ) and early diastolic (E a ) velocity by TD at the septal and lateral annular sites were measured and the E/E a ratio was computed from the average of the septal and lateral E a . This approach has been shown to yield optimum accuracy even in patients with regional wall motion abnormalities 2 …”

“…Tissue Doppler (TD) echocardiography is a novel technique that directly measures myocardial velocities 2 . The early diastolic mitral annular velocity (E a ) has been shown to be a relatively load‐independent measure of myocardial relaxation in patients with cardiac disease 3 .…”

“…When TD is combined with pulsed Doppler transmitral flow in early diastole (E), the resultant E/E a ratio has been correlated with LV filling pressure measured invasively 3,4 . Furthermore, the ratio of transmitral peak E‐wave velocity to flow propagation velocity (E/V p ) has been reported for evaluating LV filling pressure or left atrial pressure in various cardiac diseases with sinus rhythm or AF 2,5‐7 …”

Is the Ratio of Transmitral Peak E-Wave Velocity to Color Flow Propagation Velocity Useful for Evaluating the Severity of Heart Failure in Atrial Fibrillation?

“…Recently, the usefulness of the ratio of transmitral peak E-wave velocity to flow propagation velocity (E/Vp) for evaluating LV filling pressure or left atrial pressure in various cardiac diseases with sinus rhythm has been reported. [3][4][5][6] In addition, Nagueh et al demonstrated that E/Vp was significantly related to LV filling pressure even in patients with AF. 7 The circulating plasma B-type natriuretic peptide (BNP) concentration is known to be a good neurohormonal marker reflecting the severity of HF, and is elevated in patients with symptomatic or asymptomatic LV dysfunction.…”