Estimating mean pulmonary wedge pressure in patients with chronic atrial fibrillation from transthoracic Doppler indexes of mitral and pulmonary venous flow velocity.

OBJECTIVES We sought to obtain a noninvasive estimation of mean pulmonary wedge pressure (MPWP) in patients with chronic atrial fibrillation (AF). BACKGROUND It has previously been demonstrated that MPWP can be reliably estimated from Doppler indexes of mitral and pulmonary venous flow (PVF) in patients with sinus rhythm. Doppler estimation of MPWP has not been validated in patients with AF. METHODS MPWP was correlated with variables of mitral and pulmonary venous flow velocity as assessed by Doppler transthoracic echocardiography in 35 consecutive patients. The derived algorithm was prospectively tested in 23 additional patients. RESULTS In all patients the mitral flow pattern showed only a diastolic forward component. A significant but relatively weak correlation (r = -0.50) was observed between MPWP and mitral deceleration time. In 12 (34%) of 35 patients, the pulmonary vein flow tracing demonstrated only a diastolic forward component; a diastolic and late systolic forward flow was noted in the remaining 23 patients (66%). A strong negative correlation was observed between MPWP and the normalized duration of the diastolic flow (r = -0.80) and its initial deceleration slope time (r = -0.91). Deceleration time > 220 ms predicted MPWP < or = 12 mm Hg with 100% sensitivity and 100% specificity. When estimating MPWP by using the equation MPWP = -94.261 PVF deceleration time -9.831 Interval QRS to onset of diastolic PVF -16.337 Duration of PVF + 44.261, the measured and predicted MPWP closely agreed with a mean difference of -0.85 mm Hg. The 95% confidence limits were 4.8 and -6.1 mm Hg. CONCLUSIONS In patients with chronic AF, MPWP can be estimated from transthoracic Doppler study of PVF velocity signals.

[1]  H F Li,et al.  Quantitation of cardiac output with velocity-encoded, phase-difference magnetic resonance imaging. , 1995, The American journal of cardiology.

[2]  M. Hori,et al.  Transthoracic Doppler echocardiographic measurements of pulmonary venous flow velocity patterns: comparison with transesophageal measurements. , 1995, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[3]  M. C. Brunazzi,et al.  Estimation of left ventricular diastolic pressures from precordial pulsed-Doppler analysis of pulmonary venous and mitral flow. , 1994, American heart journal.

[4]  J. Gardin,et al.  Effect of imaging view and sample volume location on evaluation of mitral flow velocity by pulsed Doppler echocardiography. , 1986, The American journal of cardiology.

[5]  G. Nicolosi,et al.  Effect of atrial fibrillation on pulmonary venous flow patterns: transoesophageal pulsed Doppler echocardiographic study. , 1993, European heart journal.

[6]  S. Laniado,et al.  Pulmonary venous flow pattern--its relationship to cardiac dynamics. A pulsed Doppler echocardiographic study. , 1985, Circulation.

[7]  R L Popp,et al.  Relation of Transmitral Flow Velocity Patterns to Left Ventricle Diastolic Function: New Insights From a Combined Hemodynamic and Doppler Echocardiographic Study , 1988, Journal of the American College of Cardiology.

[8]  J. Thomas,et al.  Determination of left ventricular chamber stiffness from the time for deceleration of early left ventricular filling. , 1995, Circulation.

[9]  L. Tavazzi,et al.  Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure with and without mitral regurgitation. , 1996, Journal of the American College of Cardiology.

[10]  M. Cahalan,et al.  Estimation of Mean Left Atrial Pressure From Transesophageal Pulsed Doppler Echocardiography of Pulmonary Venous Flow , 1990, Circulation.

[11]  A. Tajik,et al.  Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Effect of different loading conditions. , 1990, Circulation.

[12]  M. Hori,et al.  Doppler echocardiographic pulmonary venous flow-velocity pattern for assessment of the hemodynamic profile in acute congestive heart failure. , 1995, American heart journal.

[13]  A. Weyman,et al.  Analysis of the early transmitral Doppler velocity curve: effect of primary physiologic changes and compensatory preload adjustment. , 1990, Journal of the American College of Cardiology.

[14]  G. Mensah,et al.  Pulmonary vein Doppler flow patterns specific for elevated left ventricular filling pressures in older cardiac patients are common in healthy adults < 40 years old. , 1995, The American journal of cardiology.

[15]  A. Klein,et al.  Doppler assessment of pulmonary venous flow in healthy subjects and in patients with heart disease. , 1991, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[16]  R. Kerber,et al.  The Effects of Atrial Fibrillation on Atrial Pressure‐ Volume and Flow Relationships , 1982, Circulation research.

[17]  L. Hatle,et al.  Demonstration of restrictive ventricular physiology by Doppler echocardiography. , 1988, Journal of the American College of Cardiology.

[18]  T. Meinertz,et al.  Simultaneous measurement of pulmonary venous flow by intravascular catheter Doppler velocimetry and transesophageal Doppler echocardiography: relation to left atrial pressure and left atrial and left ventricular function. , 1995, Journal of the American College of Cardiology.

[19]  T. LeJemtel,et al.  Atrial contraction is an important determinant of pulmonary venous flow. , 1986, Journal of the American College of Cardiology.

[20]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[21]  C. Appleton,et al.  Pulmonary venous flow velocity: relation to hemodynamics, mitral flow velocity and left atrial volume, and ejection fraction. , 1991, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[22]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[23]  H. Ihlen,et al.  Repeatability of measurements of pulmonary venous flow indices. , 1994, International journal of cardiology.

[24]  S. Glantz,et al.  Primer of Applied Regression & Analysis of Variance , 1990 .

[25]  C. Visser,et al.  Pulmonary Venous Flow as Assessed by Doppler Echocardiography , 1995, Echocardiography.

[26]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[27]  B. Gersh,et al.  The natural history of lone atrial fibrillation. A population-based study over three decades. , 1987, The New England journal of medicine.

[28]  L. Hatle,et al.  Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. , 1993, Journal of the American College of Cardiology.

[29]  J. Alpert,et al.  Atrial fibrillation: natural history, complications, and management. , 1988, Annual review of medicine.

[30]  A. Weyman,et al.  Calculation of atrioventricular compliance from the mitral flow profile: analytic and in vitro study. , 1992, Journal of the American College of Cardiology.

[31]  J. Smallhorn,et al.  Pulsed Doppler echocardiographic assessment of extraparenchymal pulmonary vein flow. , 1987, Journal of the American College of Cardiology.

[32]  J. Seward,et al.  Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. , 1994, Mayo Clinic proceedings.

[33]  L. Hatle,et al.  The Natural History of Left Ventricular Filling Abnormalities: Assessment by Two‐Dimensional and Doppler Echocardiography , 1992 .

[34]  A. Klein,et al.  Pitfalls in the Echo‐Doppler Assessment of Diastolic Dysfunction , 1993, Echocardiography.

[35]  S. Nagueh,et al.  Feasibility and accuracy of Doppler echocardiographic estimation of pulmonary artery occlusive pressure in the intensive care unit. , 1995, The American journal of cardiology.

[36]  Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. , 1994, Journal of the American College of Cardiology.

[37]  J. Tanouchi,et al.  Pulmonary venous flow velocity pattern as assessed with transthoracic pulsed Doppler echocardiography in subjects without cardiac disease. , 1991, The American journal of cardiology.

[38]  N. Nanda,et al.  Color Doppler assessment of mitral regurgitation with orthogonal planes. , 1987, Circulation.

[39]  A. DeMaria,et al.  Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements , 1978, Circulation.

[40]  M. Quiñones,et al.  Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation. , 1996, Circulation.

[41]  W. Kannel,et al.  Epidemiologic features of chronic atrial fibrillation: the Framingham study. , 1982, The New England journal of medicine.