CLINICAL STUDY
Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers
Michael S. Firstenberg, MD*,
Benjamin D. Levine, MD ,
Mario J. Garcia, MD*,
Neil L. Greenberg, PhD*,
Lisa Cardon, RDCS*,
Annitta J. Morehead, RDCS*,
Julie Zuckerman, RN and
James D. Thomas, MD*
* Cardiovascular Imaging Center in the Department of Cardiology at The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Institute for Exercise and Environmental Medicine at the Presbyterian Hospital of Dallas, Dallas, Texas, USA
Manuscript received November 17, 1999;
revised manuscript received April 19, 2000,
accepted June 26, 2000.
Reprint requests and correspondence: Dr. James D. Thomas, Department of Cardiology, Desk F15, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, Ohio 44195
thomasj{at}ccf.org
OBJECTIVES
We sought to determine the relationship between different echocardiographic indices and pulmonary capillary wedge pressures (PCWP) in normal volunteers.
BACKGROUND
Indices based on tissue Doppler (TDE) and color M-mode (CMM) echocardiography have been proposed to reflect left (LV) ventricular filling pressures. These include the ratio of early diastolic transmitral velocity (E) to early myocardial velocity measured by TDE (E') and the ratio of E to the wave propagation velocity (Vp) measured from CMM images. These indices, however, have not been validated in normal individuals.
METHODS
We studied seven volunteers during two phases of preload altering maneuvers, baseline, with two stages of lower body negative pressure, and repeat baseline with two stages of volume loading. The PCWP obtained from right heart catheterization was compared with diastolic indices using pulsed Doppler, TDE and CMM echocardiography.
RESULTS
The PCWP ranged from 2.2 to 23.5 mm Hg. During preload alterations, significant changes in E and septal E' (both p < 0.05) but not lateral E' or Vp were observed. Furthermore, E, septal E' and E/Vp correlated with PCWP (all r > 0.80) but not combined E and TDE indices (both r < 0.15). Within individuals, a similar linear relationship was observed among E/Vp, E and septal E' (average r > 0.80).
CONCLUSIONS
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.
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Abbreviations and Acronyms
| | A | = late transmitral filling velocities | | ANOVA | = analysis of variance | | CMM | = color M-mode | | DT | = transmitral deceleration time | | E | = early transmitral filling velocities | | E'lat | = early diastolic annular velocities measured in the lateral region of the mitral annulus | | E'sep | = early diastolic annular velocities measured in the septal region of the mitral annulus | | LBNP | = lower body negative pressure | | LV | = left ventricular | | PCWP | = pulmonary capillary wedge pressure | | TDE | = tissue Doppler echocardiography | | Vp | = early diastolic flow propagation velocity |
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