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Noninvasive assessment of left atrial maximum dP/dt by a combination of transmitral and pulmonary venous flow

Satoshi Nakatani, MD, FACC^a,1, Mario J. Garcia, MD, FACC^a, Michael S. Firstenberg, MD^a, Leonardo Rodriguez, MD, FACC^a, Richard A. Grimm, DO, FACC^a, Neil L. Greenberg, PhD, Patrick M. McCarthy, MD, Pieter M. Vandervoort, MD, FACC^a,2 and James D. Thomas, MD, FACC^a

^a Department of Cardiovascular Imaging Center and the Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Biomedical Engineering, The Ohio State University, Cleveland, Ohio, USA

View larger version (16K): [in a new window]   Figure 1 Left atrial pressure measured by a micromanometer-tipped catheter (upper panel) and its first derivative (lower panel). a = a wave; LAP = left atrial pressure; v = v wave; x = x trough; y = y trough.

View larger version (15K): [in a new window]   Figure 2 Relationship between left atrial pressure just before atrial contraction (pre "A" pressure) and LA dP/dtmax.

View larger version (17K): [in a new window]   Figure 3 Relationship between mean acceleration of transmitral A wave and LA dP/dtmax.

View larger version (20K): [in a new window]   Figure 4 (A) Relationship between the estimated and measured LA dP/dtmax in the test group. (B) Plot of the average value vs. the difference of the estimated and measured LA dP/dtmax.

View larger version (23K): [in a new window]   Figure 5 Relationship between the estimated and measured LA dP/dtmax in all patients. Points connected with lines represent data obtained from the same individual. Open circles denote the study patients and the closed circles denote the test patients.

View larger version (20K): [in a new window]   Figure 6 Results of mathematical modeling demonstrating the relationship between LA dP/dtmax and the acceleration of the transmitral A wave (A) and the peak velocity of the pulmonary AR wave (B).