Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure even when atrial fibrillation is present.
OBJECTIVE
In patients with chronic congestive heart failure a high pulmonary artery wedge pressure (PAWP) is associated with poor prognosis, severe symptoms and low exercise tolerance. When atrial fibrillation is present the non-invasive prediction of PAWP by Doppler echocardiography is generally considered to be not reliable.


METHODS
In 51 consecutive patients with chronic heart failure, due to either ischemic and non-ischemic dilated cardiomyopathy, and atrial fibrillation simultaneous Doppler echocardiographic and hemodynamic studies were used to estimate PAWP. The power of the obtained multivariate equation was compared with that of previously developed equations and was then prospectively tested in a group of 15 patients.


RESULTS
The deceleration rate (DR) of early diastolic mitral flow, the left ventricular iso-volumic relaxation time (IVRT) and the systolic fraction of pulmonary venous flow (SF) were independent predictors of PAWP and the following multivariable equation was derived: PAWP=24.04 + 1.23 x DR- 0.089 x IVRT - 0.175 x SF. The correlation between invasive PAWP and the PAWP non-invasively estimated by this equation in the testing group was 0.91 (standard error of estimate=3.2 mmHg). The mean difference was 0.93 and the standard error of differences was 2.7 mmHg.


CONCLUSIONS
In patients with chronic heart failure due to dilated cardiomyopathy who are in atrial fibrillation a relatively accurate estimation of PAWP can be obtained by Doppler echocardiography of mitral and pulmonary venous flow.
Department of Cardiology, Montescano Medical Center, S. Maugeri Foundation Montescano, Pavia, Italy. etraversi.montescano@fsm.it
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Traversi
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Cobelli
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Pozzoli
D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology*