title: Estimation of pulmonary capillary wedge pressure from M-mode mitral echograms.
abstract: We investigated whether the isovolumic relaxation time (IRT) and an interval from the start of opening to the maximal amplitude of the anterior mitral leaflet in early diastole (D-E interval) would be useful predictors of the pulmonary capillary wedge pressure (PCWP). We recorded M-mode mitral echograms and phonocardiograms in 33 patients (aged 38-70 years) with acute myocardial infarction (AMI) in the coronary care unit and in 34 patients (aged 40-75 years) with prior myocardial infarction (OMI) during cardiac catheterization. All patients underwent the insertion of a flow-directed pulmonary artery catheter to obtain the PCWP. We measured the IRT and the D-E interval from the phonocardiograms and the M-mode echograms. There was no significant correlation between the IRT and the mean PCWP (mPCWP) in patients with AMI and in patients with OMI. The D-E interval was significantly and inversely correlated with the mPCWP (r = -0.91, p <0.0001) in all patients. The regression equation was mPCWP = -0.42 x (D-E) +47.9. The D-E interval of < or = 75 ms indicated a high mPCWP (mPCWP > or = 18 mm Hg) with high sensitivity (96%) and specificity (88%). The derived equation was tested in a prospective group of 32 additional patients (aged 43-75 years). A significant correlation was observed between the predicted and measured mPCWP (r = 0.91, p <0.0001). Thus, the PCWP can be estimated by using the D-E interval derived from M-mode mitral echograms in patients in the coronary care unit and in patients with chronic heart disease.
authors.affiliation: Third Department of Internal Medicine, Nagoya City University Medical School, Mizuho-ku, Nagoya, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Akita
authors.forename: N
authors.initials: N
authors.lastname: Ohte
authors.forename: H
authors.initials: H
authors.lastname: Narita
authors.forename: T
authors.initials: T
authors.lastname: Hashimoto
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Fujinami
mesh_terms: D000328:Adult; D000368:Aged; D003325:Coronary Care Units / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015588:Observer Variation; D010701:Phonocardiography; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D012044:Regression Analysis; D012680:Sensitivity and Specificity