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.
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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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