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CLINICAL STUDIES

Noninvasive evaluation of pulmonary capillary wedge pressure in patients with acute myocardial infarction by deceleration time of pulmonary venous flow velocity in diastole

Atsushi Yamamuro, MD^*, Kiyoshi Yoshida, MD, FACC^*, Takeshi Hozumi, MD^*, Takashi Akasaka, MD^*, Tsutomu Takagi, MD^*, Shuichirou Kaji, MD^*, Takahiro Kawamoto, MD^* and Junichi Yoshikawa, MD, FACC

^* Division of Cardiology, Kobe General Hospital, Kobe, Japan
Osaka City University School of Medicine, Osaka, Japan

Manuscript received October 30, 1998; revised manuscript received February 25, 1999, accepted March 31, 1999.

Reprint requests and correspondence Dr. Atsushi Yamamuro, Minatojima-nakamachi 4-6, Chuo-ku, Kobe, 650, Japan
jse{at}warp-or-.jp

OBJECTIVES

This study investigates the correlation between deceleration time of diastolic pulmonary venous flow (PV-DT) and of early filling mitral flow (LV-DT), and pulmonary capillary wedge pressure (PCWP) in patients with acute myocardial infarction (AMI).

BACKGROUND

An earlier study suggests that Doppler-derived LV-DT provides an accurate means of estimating PCWP in postinfarction patients with left ventricular systolic dysfunction. Furthermore, recent studies have suggested that PCWP correlates better with PV-DT than with LV-DT. However, the value of PV-DT and LV-DT for assessment of PCWP in patients with AMI has not been evaluated.

METHODS

In 141 consecutive patients with AMI, we measured PV-DT and LV-DT by Doppler echocardiography, and compared these variables with PCWP measured using a Swan-Ganz catheter.

RESULTS

There was a weak negative correlation between the LV-DT and PCWP (r = –0.54). Although the sensitivity of 130 ms in LV-DT in predicting 18 mm Hg in PCWP was high (86%), its specificity was low (59%). On the other hand, a very close negative correlation was found between PV-DT and PCWP (r = –0.89). The sensitivity and specificity of 160 ms in PV-DT in predicting 18 mm Hg in PCWP were 97% and 96%, respectively.

CONCLUSIONS

In patients with AMI, Doppler-derived PV-DT showed a stronger correlation with PCWP than LV-DT.

Abbreviations and Acronyms   AMI = acute myocardial infarction   LV-DT = deceleration time of early filling mitral flow   LVEDV = left ventricular end-diastolic volume   LVESV = left ventricular end-systolic volume   PCWP = pulmonary capillary wedge pressure   PV-DT = deceleration time of diastolic pulmonary venous flow   PVF = pulmonary vinous flow

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