title: An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure.
abstract: OBJECTIVE
  This study sought to determine the applicability of the combined information obtained from transmitral Doppler flow and color M-mode Doppler flow propagation velocities for estimating pulmonary capillary wedge pressure.
  
  
  BACKGROUND
  Although Doppler-derived measurements of left ventricular (LV) filling have been applied to determine left atrial pressure, their accuracy has been limited by the variable effect of ventricular relaxation in these indexes. Recently, flow propagation velocity measured by color M-mode Doppler echocardiography has been suggested as an index of ventricular relaxation.
  
  
  METHODS
  We studied 45 patients admitted to the intensive care unit who underwent invasive hemodynamic monitoring. We measured peak early (E) and late (A) transmitral Doppler velocities, E/A ratio and flow propagation velocity (vp) and compared them by linear regression with pulmonary capillary wedge pressure (pw).
  
  
  RESULTS
  We found a modest positive correlation between pw and E (r = 0.62, p < 0.001) and the E/A ratio (r = 0.52, p < 0.001) and a negative correlation between pw and vp (r = -0.34, p = 0.02). By stepwise linear regression, only E and vp were statistically significant predictors of pw. However, the E/vp ratio provided the best estimate of pw (r = 0.80, p < 0.001; pw = 5.27 x [E/vp] + 4.6, SEE 3.1 mm Hg).
  
  
  CONCLUSIONS
  The ratio of component velocity (E) over the color M-mode propagation velocity during early LV filling, by correcting for the effect of LV relaxation, provides a better estimate of pw than standard measurements of transmitral Doppler flow.
authors.affiliation: Veterans Affairs Medical Center, White River Junction, Vermont, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Garcia
authors.forename: M A
authors.initials: MA
authors.lastname: Ares
authors.forename: C
authors.initials: C
authors.lastname: Asher
authors.forename: L
authors.initials: L
authors.lastname: Rodriguez
authors.forename: P
authors.initials: P
authors.lastname: Vandervoort
authors.forename: J D
authors.initials: JD
authors.lastname: Thomas
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D018618:Echocardiography, Doppler, Color; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D016277:Ventricular Function, Left