Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers

Abstract

In subjects without heart disease, E, septal E' and E/Vp correlate with PCWP. Because the influence of ventricular relaxation is minimized, the ratio E/Vp may be the best overall index of LV filling pressures.

Diastolic Filling and Pressure Imaging: Taking Advantage of the Information in a Colour M-mode Doppler Image

“…Firstenberg et al [63] reported a relationship between load and E/v p in a population of healthy volunteers. In contrast, Garcia et al [48] has studied a heterogeneous population of patients.…”

“…In contrast, in multivariate analysis, most studies were not able to demonstrate a significant [47] , in a multivariate model, both the relaxation constant and the difference between left ventricular pressure at mitral valve opening and minimal left ventricular pressure remained simultaneously significant variables for determining v p . Moreover, several experimental studies [59,[62][63][64][65][66] reported no significant change in v p for altering loading conditions including volume loading, caval constriction, Trendelburg's position, inverse Trendelberg's position, after inhalation of amyl nitride and during lower body negative pressure.…”

“…As the main determinants of pulsed wave Doppler peak E-velocity are left atrial pressure and left ventricular relaxation, several authors propose the ratio of E and v p as an index of left atrial pressure, left ventricular end-diastolic pressure or pulmonary capillary wedge pressure [48,61,63,69,70] . Thus, v p is believed to correct for the load-dependency of E. All studies propose a linear relationship of the form:…”

Echocardiographic evaluation of diastolic heart failure

“…The ratio of E/Vp has been used to estimate LV filling pressure, with an E/Vp > 1.5 suggestive of a PCWP > 15 mm Hg 65 , 66 . Vp is influenced by LV systolic function, which may act to normalise Vp in the presence of impaired LV relaxation 67 , 68 .…”

“…Recent evidence suggests that E’ velocity at the septal and lateral annulus are affected by different variables and are not interchangeable 101 . Moreover, septal E’ velocity has been demonstrated to be preload dependent in patients with normal LV function 102 , although this effect may decrease as LV relaxation becomes progressively impaired. Additionally, septal E’ velocity may be influenced by right ventricular diastolic function.…”