Assessment of left ventricular filling pressure in myocardial infarction using the first derivative of the apexcardiogram.
We recorded the apexcardiogram (ACG) and its first derivative (dA/dt) in 24 patients with acute or recent myocardial infarction. From dA/dt, an index I = X 10 dRFW/dS was defined (dRFW and dS = peaks of dA/dt corresponding to the rapid filling wave and to the systolic upstroke of the ACG). A significant correlation was found between I and pulmonary capillary wedge pressure (PCW, mmHg). PCW = 2.3 X I + 6.5 (r = 0.80, p less than 0.001). Normal PCW was found in 15 patients who all had an I less than 2.8. Elevated PCW was found in 9 patients who all had an I greater than 2.8. Thus the ability of I to predict elevated PCW was 100% (95% confidence limit greater than 66.4%). The ability to predict normal PCW was 100% (95% confidence limit greater than 76.2%). No significant correlation was found between I and cardiac index (r = 0.29, p greater than 0.1).
D000328:Adult; D000368:Aged; D002302:Cardiac Output; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007702:Kinetocardiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology*; D010701:Phonocardiography; D011669:Pulmonary Wedge Pressure