Shortened Doppler-derived mitral A wave deceleration time: an important predictor of elevated left ventricular filling pressure.
OBJECTIVE
The aim of this study was to investigate whether a new variable of mitral inflow, A wave deceleration time, identifies patients with elevated left ventricular filling pressures.


BACKGROUND
In patients with an elevated left ventricular end-diastolic pressure, the increase in left ventricular pressure after atrial contraction rapidly exceeds left atrial pressure, resulting in abrupt cessation of the A wave. Therefore, we postulated that a shortening of A wave deceleration time might be a marker for elevated end-diastolic pressure.


METHODS
Adequate pulsed Doppler mitral inflow velocities could be recorded in 40 of 44 consecutive patients undergoing cardiac catheterization with capillary wedge pressure in 20 patients, and within 1 h after left ventricular end-diastolic pressure recording in 20. Fifteen healthy volunteers were also studied.


RESULTS
Left ventricular end-diastolic pressure was 8 to 35 mm Hg, and mean pulmonary wedge pressure was 6 to 37 mm Hg. Close correlations were found between A wave deceleration time and mean pulmonary wedge pressure (r = -0.87) and left ventricular end-diastolic pressure (r = -0.74). There were modest correlations between both pressures and peak E/A, E wave deceleration time and A wave duration, respectively; r = 0.59, -0.30 and -0.58 for capillary wedge and r = 0.25, -0.38 and -0.49 for end-diastolic pressures. A wave deceleration time </= 60 ms predicted left ventricular end-diastolic and mean pulmonary wedge pressures > 18 mm Hg, respectively, with a sensitivity of 67% and 89% and specificity of 100% for both.


CONCLUSIONS
A shortened Doppler mitral inflow A wave deceleration time is a useful index of elevated left ventricular filling pressure.
Tenenbaum
A
A
Heart Institute, Sheba Medical Center, Tel Aviv, Israel.
Motro
M
M
Hod
H
H
Kaplinsky
E
E
Vered
Z
Z
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D003654:Deceleration; D015150:Echocardiography, Doppler; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D017725:Ventricular Pressure