Non-invasive monitoring of pulmonary capillary wedge pressure in heart failure.
OBJECTIVE
To evaluate the usefulness of pulsed Doppler (PD) mitral flow E wave deceleration time (EDcT) to detect and quantify changes of pulmonary capillary wedge pressure (PCWP) in patients (pt) with dilated chronic heart failure (CHF) submitted to tailored therapy.


METHODS
In 14 pt with dilated cardiomyopathy (DCM) (59.4+/-10.0 years, 11 males, sinus rhythm), admitted to the ICU because of worsening CHF, serial simultaneous hemodynamic and echocardiographic studies were performed (3-5/pt; overall 49 evaluations). PD mitral flow register was used to measure EDcT and correlated with PCWP at each study.


RESULTS
PCWP ranged from 36 to 3 mmHg (17.6+/-8.8) and EDcT from 271 to 52 ms (104.9+/-42.4). The correlation between EDcT and PCWP was -0.65 (PCWP=31.7-0.134EDcT). Using this equation to calculate PCWP, individual absolute values difference (identity error - IE) was 5.6+/-3.5 mmHg (0.4-14.6). In 29 cases (59.2%) IE was >5 mmHg, defined as major error. Considering EDcT percent change (delta%EDcT) and PCWP variation (deltaPCWP) in serial evaluations, we found a correlation of -0.87 (deltaPCWP=-2.83-0.19 delta%EDcT). Using this equation, the IE was 2.3+/-1.6 mmHg (0-5.2) and there were only two (6%) major errors (P<0.0001).


CONCLUSIONS
In pt with DCM and advanced CHF, EDcT shows a reasonable correlation with PCWP, but when it is used to calculate PCWP the IE to hemodynamic values is often large. However, our results with EDcT percent change in serial evaluations using a first simultaneous invasive determination, suggest that this technique is reliable for monitoring PCWP and can be particularly useful for pt submitted to tailored therapy.
Martins
S
S
Department of Cardiology, Hospital de Santa Marta, Lisbon, Portugal.
Soares
R M
RM
Branco
L
L
Salomão
S
S
Antunes
A M
AM
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001795:Blood Pressure Determination / Q000379:methods; D006328:Cardiac Catheterization; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure / Q000502:physiology*