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CLINICAL STUDIES

Combined use of pulsed and color M-mode doppler echocardiography for the estimation of pulmonary capillary wedge pressure: an empirical approach based on an analytical relation

Francisco Gonzalez-Vilchez, MD, PhD^*, Miguel Ares, MD, Jose Ayuela, MD^* and Luis Alonso, MD^a

^a Cardiology Section, Service of Internal Medicine, Hospital General Yagüe, Burgos, Spain
^* Intensive Care Unit, Hospital General Yagüe, Burgos, Spain
the Cardiology Section, Service of Internal Medicine, Hospital de Laredo, Cantabria, Spain

Manuscript received July 8, 1998; revised manuscript received March 16, 1999, accepted April 22, 1999.

OBJECTIVES

We sought a noninvasive estimation of pulmonary capillary wedge pressure (Pw) by means of the information obtained from transmitral pulsed Doppler and color M-mode Doppler flow propagation velocity (FPV).

BACKGROUND

Pulsed Doppler parameters have limited accuracy for the estimation of Pw because they are determined by left atrial pressure and other parameters such as ventricular relaxation. Recently, a good correlation has been found between the rate of ventricular relaxation (, tau) and FPV measured by color M-mode Doppler echocardiography.

METHODS

We studied 20 patients who underwent invasive hemodynamic monitoring. By multilinear regression analysis, the relationships between Pw and Doppler parameters, FPV, and a noninvasive estimate (P_est) based on the Weiss’ equation (substituting tau for 1/FPV) were determined. A simplified index based on the results obtained was then tested in an additional group of 34 patients.

RESULTS

By multiple regression analysis only isovolumic relaxation time (IVRT) (p = 0.0096) and P_est (p = 0.0043) were related to Pw. A derived empirical index, 10³/([2·IVRT]+FPV), was strongly correlated with Pw in the entire group according to the regression equation Pw = 4.5·(10³/[{2·IVRT} + FPV]) – 9 (r = 0.89, p < 0.0001, [standard error of the estimate] SEE = 3.3 mm Hg). The sensitivity and specificity for the prediction of Pw > 15 mm Hg were 90% and 100%, respectively.

CONCLUSIONS

The combined use of FPV as a surrogate for tau and IVRT permits a close prediction of Pw.

Abbreviations and Acronyms   FPV = flow propagation velocity   IVRT = isovolumic relaxation time   LV = left ventricular   Pw = pulmonary capillary wedge pressure   Pest = estimate of pulmonary capillary wedge pressure calculated by Weiss’ equation after substituting time constant of isovolumetric LV relaxation for 1/FPV, t for IVRT and Po for 0.9·systolic blood pressure   SEE = standard error of the estimate   tau, = time constant of isovolumic left ventricular relaxation

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