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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

View larger version (106K): [in a new window]   Figure 1 Transesophageal pulsed-wave Doppler showing a biphasic slope of deceleration of the diastolic wave (D) of pulmonary venous flow. The deceleration time of the D wave is measured as the time interval between peak velocity and the upper deceleration slope extrapolated to zero. The deceleration time in this case is 223 ms.

View larger version (12K): [in a new window]   Figure 2 Scatterplot of the correlation between deceleration time of the diastolic wave of pulmonary venous flow (DTD) and mean left atrial pressure (PLA). Data are plotted for group 1 combined with group 2. The horizontal dashed line indicates a DTD of 175 ms, which predicted a PLA of >17 mm Hg, with 100% sensitivity and 98% specificity.

View larger version (11K): [in a new window]   Figure 3 Scatterplot of the correlation between estimated mean left atrial pressure (PLA) (calculated from the deceleration time of diastolic pulmonary venous flow [DTD] using the derived quadratic regression equation) and the directly measured PLA in group 2.

View larger version (15K): [in a new window]   Figure 4 Bland-Altman plot of the differences between estimated mean left atrial pressure (PLA) using the deceleration time of diastolic wave and actual PLA versus the actual PLA. The 95% confidence intervals for PLA estimation are –2.94 to 4.10 mm Hg and are shown by dashed lines.

View larger version (10K): [in a new window]   Figure 5 Scatterplot of the correlation between pulmonary artery occlusion pressure (PPAO) and mean left atrial pressure (PLA). The tendency for the PPAO to overestimate the PLA is apparent from this plot.