title: Noninvasive estimation of left atrial pressure in patients with congestive heart failure and mitral regurgitation by Doppler echocardiography.
abstract: A completely noninvasive method for estimating left atrial pressure in patients with congestive heart failure and mitral regurgitation has been devised with the use of continuous-wave Doppler echocardiography and brachial sphygmomanometry. Of 46 patients studied with mitral regurgitation, 35 (76%) had jets with distinct Doppler spectral envelopes recorded. The peak ventriculoatrial gradient was obtained by measuring peak mitral regurgitant velocity in systole and using the modified Bernoulli equation. This gradient was then subtracted from peak brachial systolic blood pressure, an estimate of left ventricular systolic pressure, to yield left atrial pressure (left atrial pressure = systolic blood pressure - mitral regurgitant pressure gradient). Noninvasive estimates of left atrial pressure from 35 patients were plotted against simultaneous recordings of mean pulmonary capillary wedge pressure resulting in the correlation y = 0.88x + 3.3, r = 0.88, standard error of estimate = +/- 4 mm Hg (p less than 0.001). Therefore, continuous-wave Doppler echocardiography and sphygmomanometry may be used in selected patients with congestive heart failure and mitral regurgitation for noninvasive estimation of left atrial pressure.
authors.affiliation: Division of Cardiology, Medical College of Virginia, Richmond 23298.
authors.forename: J
authors.initials: J
authors.lastname: Gorcsan
authors.forename: F R
authors.initials: FR
authors.lastname: Snow
authors.forename: W
authors.initials: W
authors.lastname: Paulsen
authors.forename: J V
authors.initials: JV
authors.lastname: Nixon
mesh_terms: D016279:Atrial Function, Left / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods; D001916:Brachial Artery / Q000502:physiology; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D005069:Evaluation Studies as Topic; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D011669:Pulmonary Wedge Pressure / Q000502:physiology