LETTER TO THE EDITOR
Pulmonary venous flow by Doppler echocardiography: usefulness of diastolic wave deceleration time in predicting filling pressures
Stephane Arques, MD and
Emmanuel Roux, MD
Department of Cardiology, Aubagne Hospital, Avenue des S urs Gastine 13400, Aubagne, France
sarques{at}ch-aubagne.rss.fr
I read with great interest the study by Tabata et al. (1), which reviews all the current applications of measuring pulmonary venous flow by Doppler echocardiography. As reported by the investigators, measurement of pulmonary capillary pressure and left ventricular end-diastolic pressure may utilize either the systolic fraction or the difference between pulmonary venous atrial reverse-wave duration and mitral inflow atrial-wave duration. Noninvasive assessment of filling pressures with Doppler methods represents a promising tool in diagnosing and monitoring heart failure (2); thus, it appears of interest to point out the clinical usefulness of the deceleration time of the pulmonary venous diastolic flow, which has been well correlated to invasive pulmonary capillary pressure in several studies regardless of left ventricular systolic function and rhythm (3–7). Furthermore, a recent work by Kinnaird et al. (8) has reported its better accuracy than the pulmonary artery occlusion pressure in predicting left atrial pressure. At present, the usefulness of the deceleration time of pulmonary venous diastolic flow is limited in practice by the difficulty to record the pulmonary venous flow from apical windows in critically ill patients (7); nevertheless, the steady improvement of the quality of Doppler echocardiographs will increase its feasibility in the coming years.
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References
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- Tabata T, Thomas JD, Klein AL. Pulmonary venous flow by Doppler echocardiography: revisited 12 years later. J Am Coll Cardiol. 2003;41:1243–1250[Abstract/Free Full Text]
- Arques S, Ambrosi P, Gelisse R, Luccioni R, Habib G. Hypoalbuminemia in elderly patients with acute diastolic heart failure. J Am Coll Cardiol. 2003;42:712–716[Abstract/Free Full Text]
- Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Effect of different loading conditions. Circulation. 1990;81:1488–1497[Abstract/Free Full Text]
- Chirillo F, Brunazzi MC, Barbiero M, et al. Estimating mean pulmonary wedge pressure in patients with chronic atrial fibrillation from transthoracic Doppler indexes of mitral and pulmonary venous flow velocity. J Am Coll Cardiol. 1997;30:19–26[Abstract]
- Yamamuro A, Yoshida K, Ozumi T, et al. Noninvasive evaluation of pulmonary capillary wedge pressure in patients with acute myocardial infarction by deceleration time of pulmonary venous flow velocity in diastole. J Am Coll Cardiol. 1999;34:90–94[Abstract/Free Full Text]
- Matsukida K, Kisanuki A, Toyonaga K, et al. Comparison of transthoracic Doppler echocardiography and natriuretic peptides in predicting mean pulmonary capillary wedge pressure in patients with chronic atrial fibrillation. J Am Soc Echocardiogr. 2001;14:1080–1087[CrossRef][Medline]
- Gonzalez-Vilchez F, Ayuela J, Ares M, Mata NS, Gonzalez AG, Duran RM. Comparison of Doppler echocardiography, color M-mode Doppler, and Doppler tissue imaging for the estimation of pulmonary capillary wedge pressure. J Am Soc Echocardiogr. 2002;15:1245–1250[CrossRef][Medline]
- Kinnaird TD, Thompson CR, Munt BI. The deceleration time of pulmonary venous diastolic flow is more accurate than the pulmonary artery occlusion pressure in predicting left atrial pressure. J Am Coll Cardiol. 2001;37:2025–2030[Abstract/Free Full Text]
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