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CLINICAL STUDY: ECHOCARDIOGRAPHY

The deceleration time of pulmonary venous diastolic flow is more accurate than the pulmonary artery occlusion pressure in predicting left atrial pressure

Tim D. Kinnaird, MB, BCh, Christopher R. Thompson, MD, FACC^* and Bradley I. Munt, MD, FACC^*

^* Cardiac Echo Laboratory, St. Paul’s Hospital, Vancouver, British Columbia, Canada
Department of Cardiology, London Chest Hospital, London, United Kingdom

Manuscript received July 31, 2000; revised manuscript received February 16, 2001, accepted March 1, 2001.

Reprint requests and correspondence: Dr. Tim Kinnaird, Department of Cardiology, London Chest Hospital, Bonner Road, London, United Kingdom, E2 9JX
tkinnaird{at}113offord.freeserve.co.uk

OBJECTIVES

This study compared a prediction of mean left atrial pressure (P_LA) ascertained by Doppler echocardiography of pulmonary venous flow (PVF), with predicted P_LA using the pulmonary artery occlusion pressure (P_PAO).

BACKGROUND

In select patient groups, PVF variables correlate with P_PAO, an indirect measure of P_LA.

METHODS

In 93 patients undergoing cardiac surgery, we recorded with transesophageal echocardiography mitral valve early (E) and late (A) wave velocities, deceleration time (DT) of E (DT_E), and pulmonary vein systolic (S) and diastolic (D) wave velocities, DT of D (DT_D) and systolic fraction. The P_PAO was measured using a pulmonary artery catheter zeroed to midaxillary level. A further catheter was held at midatrial level to zero a transducer and was then inserted into the left atrium. A prediction rule for P_LA from DT_D was developed in 50 patients and applied prospectively to estimate P_LA in 43 patients.

RESULTS

A close correlation (r = –0.92) was found between P_LA and DT_D. Systolic fraction (r = –0.63), DT_E (r = –0.61), D wave (r = 0.57), E wave (r = 0.52), and E/A ratio (r = 0.13) correlated less closely with P_LA. The mean difference between predicted and measured P_LA was 0.58 mm Hg for DT_D method and 1.72 mm Hg for P_PAO, with limits of agreement (mean ± 2 SE) of –2.94 to 4.10 mm Hg and –2.48 to 5.92 mm Hg, respectively. A DT_D of <175 ms had 100% sensitivity and 94% specificity for a P_LA of >17 mm Hg.

CONCLUSIONS

Deceleration time of pulmonary vein diastolic wave is more accurate than P_PAO in estimating left atrial pressure in cardiac surgical patients.

Abbreviations and Acronyms   A = late mitral inflow   CI = confidence interval   D = diastolic pulmonary vein flow   DTD = deceleration time of diastolic pulmonary vein flow   DTE = deceleration time of early mitral inflow   E = early mitral inflow   PLA = mean left atrial pressure   PPAO = pulmonary artery occlusion pressure   PVF = pulmonary venous flow   S = systolic pulmonary vein flow   SE = standard error

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