Noninvasive Estimation of Pulmonary Capillary Wedge Pressure from Pulmonary Venous Flow Using Transesophageal Doppler Echocardiography

Abstract

We prospectively examined the relationship between pulmonary venous flow velocity determined by transesophageal echocardiography and pulmonary capillary wedge pressure (PCWP) determined with a Swan-Ganz catheter in 40 consecutive patients who were all in sinus rhythm and without significant mitral valve disease. Correlations were assessed between the four components of pulmonary venous flow – atrial reversal flow (A), early systolic (SI) and late systolic (S2) forward flow, and diastolic forward flow (D) – and PCWP. Multiple regression analysis showed that PCWP could be estimated from only two (S2 and D) among these four components. Thus, PCWP was estimated by using the following equation with a strong correlation (r = 0.83) to measured one by catheterization: PCWP = –0.07 × S2+0.27 × D+2.3 mm Hg. In addition, prospective estimation of PCWP by this equation in an additional 25 patients gave a good correlation with the measured values (r = 0.83). PCWP can be estimated by our new equation using the peak velocity of late systolic forward and diastolic forward flow in pulmonary vein in patients with various types of heart diseases.

Echocardiographic assessment of pulmonary artery occlusion pressure in ventilated patients: a transoesophageal study

“…As previously reported in cardiac patients [ 8 , 9 , 35 , 36 ], the relationship between Doppler indices and invasive PAOP was closer in our patients with LV systolic dysfunction. This would help the physician to confidently identify a cardiogenic pulmonary oedema in the presence of Doppler velocity profiles consistent with elevated PAOP since heart failure patients typically exhibit high LV filling pressures.…”

“…By contrast, only few Doppler studies have yet been conducted in ventilated ICU patients [ 14 - 19 ], and frequently comprised patients with known cardiac disease [ 18 , 19 ]. Moreover, initial studies frequently attempted to estimate the absolute value of invasive PAOP using several Doppler indices combined in complex equations [ 8 , 9 , 13 , 18 , 19 ], whereas semi-quantitative evaluation of LV filling pressure based on simple yet robust, easy-to-measure parameters appears more adapted in the ICU environment. Finally, only two studies have previously assessed the ability of mitral and pulmonary venous flow Doppler to predict a PAOP ≤ 18 mmHg in ventilated ICU patients [ 14 , 15 ] and studies using DTI and colour Doppler indices have unfortunately focused on the prediction of lower levels of PAOP [ 16 , 17 ].…”

Relationship between transesophageal echocardiography-derived pulmonary artery systolic pressure measurements and early morbidity in patients undergoing coronary artery bypass grafting

“…[ 15 ] Currently, one of the most effective and common methods in the treatment of ischemic heart disease is coronary artery surgery. As has been reported earlier in patients with serious cardiac illnesses,[ 16 17 18 19 20 ] the Doppler velocity profiles have a close association with values obtained with invasive pulmonary artery occlusion pressure (PAOP) monitoring in the presence of significant LV systolic dysfunction. This implies that clinicians can diagnose definitive cardiogenic pulmonary edema when the Doppler indices are suggesting an increased PAOP since patients with cardiac failure characteristically have elevated LV filling pressures.…”