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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

View larger version (116K): [in a new window]   Figure 1 Measurements of isovolumic relaxation time (IVRT) and flow propagation velocity (FPV) in a patient with normal wedge pressure (actual pressure = 10 mm Hg) (panels A and B) and in a patient with high wedge pressure (actual pressure = 31 mm Hg) (panels C and D). In the first case, FPV is determined by the slope of the first aliasing line during early filling, from the mitral valve plane distally into the left ventricular cavity (panel B). Estimated wedge pressure = 13.5 mm Hg. In the second case, FPV is determined by the slope of the first clearly demarcated isovelocity line during early filling (panel D). Estimated wedge pressure = 28.8 mm Hg.

View larger version (19K): [in a new window]   Figure 2 (A) Linear regression between Doppler estimates and catheter measurements of pulmonary capillary wedge pressure (Pw). (B) Bland-Altman analysis of agreement between the estimated and measured Pw. (The middle solid line indicates the average difference between the two methods, whereas the outer dashed lines represent 2 SD or the 95% limits of agreement.) Circles = test population; Squares = training population.

View larger version (20K): [in a new window]   Figure 3 Influence of left ventricular systolic performance on the correlation between mean pulmonary capillary wedge pressure (Pw) and: (A) E peak velocity/Flow propagation velocity (FPV) and (B) the parameter 103/([2·IVRT] + FPV). IVRT = isovolumic relaxation time. Dashed lines and open squares = patients with left ventricular ejection fraction >50%; Solid lines and solid squares = patients with left ventricular ejection fraction 50%.

View larger version (15K): [in a new window]   Figure 4 Comparison of predicted and observed changes in pulmonary arterial wedge pressure (Pw) in response to standard therapy.