[Transthoracic recording of pulmonary venous flow for diagnosis of high pulmonary capillary wedge pressure].
69 patients (46 men, 23 women, age 34 to 78 mean 56 years, all in sinus rhythm) with suspected cardiac insufficiency underwent transthoracic Doppler echocardiography followed by hemodynamic measurement of the pulmonary capillary wedge pressure (= PCP). The echocardiographic measurements included: 1) the peak systolic (S) and diastolic (D) pulmonary venous flow (PVF) velocity (all patients); 2) the E and A peak velocity (62 patients) and 3) the deceleration time (DT, 57 patients) of the mitral flow curve (mean values from 5 to 15 beats). PCP was high (> or = 15 mm Hg) in 27 patients and low (< or = 14 mm Hg) in 42. There were significant correlations between the PCP and all 3 echo parameters: (PCP-S/D: r = -0.69, PCP-E/A: r = 0.66 PCP-DT: r = -0.48, p < 0.05 for all correlations). The sensitivity, specificity, positive and negative predictive accuracy of a pulmonary venous S/D ratio < 1.0 for detecting a high PCP were 82, 83, 76 and 88% respectively, which is similar to the results of previous transesophageal studies. However, slightly reduced S/ID ratios (0.8 to 0.99) were often associated with a normal PCP, and only ratios below 0.8 should be considered as indicative of a high PCP. The mitral flow parameters E/A > or = 1.5 and DT < or = 0.12 s were equally useful in detecting a high PCP: sensitivity, specificity, positive and negative predictive accuracy were 68 and 86, 90 and 80%, 79 and 73%, 84 and 90% respectively. However, E/A ratios between 1.0 and 1.49 were not very useful, representing a high PCP in one third of the cases. There were significant correlations and a high degree of agreement in predicting a high or low PCP between the three Doppler echo parametes, particularly between S/D and E/A ratios. The analysis of pulmonary venous flow by transthoracic echocardiography is a useful method for the non-invasive detection of a high PCP. However, this method no more accurate than the much simpler analysis of mitral flow. The application of the pulmonary venous flow method is indicated when mitral flow cannot be interpreted, for example because of tachycardia, aortic incompetence or an E/A ratio in the ambiguous range (1.0 to 1.49).
Kronik
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G
Internen Abteilung des A.ö. Krankenhauses Krems.
Nuhr
M
M
Glaser
F
F
Rohla
M
M
D000328:Adult; D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D013599:Systole