[The remote noninvasive assessment of left ventricular diastolic pressure by pulsed Doppler echography--the importance of the time of mitral protodiastolic deceleration].
To find a possible correlation between the transmitral diastolic flow, obtained by pulsed Doppler echocardiography, and left ventricular end-diastolic pressure (LVedP), we studied 95 patients (p) (58 +/- 9 years), with coronary artery disease (76 p) and dilated cardiomyopathy (19 p). P with atrial fibrillation, heart rate > 100 b/m or mitral regurgitation > 2+/4+ were excluded. We analyzed E and A wave peak velocities (v), time-velocity integrals (i) and diastolic filling intervals. Restriction to filling pattern was considered in the presence of an E wave deceleration time (DecT) < or = 120 ms (Group B- 22 p); the other 73 p (group A) ranged from abnormal relaxation to normal diastolic patterns, with DecT > 120 ms.


RESULTS
-LVedP ranged from 3 to 38 mmHg in group A and from 16 to 39 mmHg in group B. In group A, the Ai/Ei ratio showed a significant linear correlation with the LVedP (r = 0.83, y = 14 chi + 2); Ai/El ratio > 1.0 identified pts with LVedP > 18 mmHg with a sensitivity of 85% and a specificity of 98%. In group B, there was a correlation between LVedP and the inverse ratio of integrals (Ei/Ai) (r = 0.72), as well as Ev/Av ratio (r = 0.69).


CONCLUSIONS
In myocardial active relaxation abnormalities, Ai/Ei ratio increases proportionally to LVedP. A short DecT (< or = 120 ms) identifies a subgroup of p with predominant impairment of LV compliance and high filling pressures, in which the atrial contribution decreases as LVedP rises. Thus, whatever the prevailing mechanism of diastolic dysfunction, echo-Doppler transmitral diastolic flow can provide a noninvasive assessment of LVedP.
Nunes
H
H
Serviço de Cardiologia, Hospital de Santa Marta, Lisboa.
Soares
R
R
Valério
L
L
Pereira
H
H
Branco
L
L
Abreu
A
A
Abreu
J
J
Bernardes
L
L
Sousa
M J
MJ
Quininha
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D003971:Diastole; D015150:Echocardiography, Doppler / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left
Avaliação não invasiva da pressão telediastólica do ventrículo esquerdo por eco-Doppler pulsátil--importância do tempo de desaceleração protodiastólica mitral.