Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit.
OBJECTIVE
To determine whether Doppler transmitral and pulmonary venous flow pattern is related to left ventricular filling pressures in critically ill patients.


METHODS
Prospective clinical investigation.


METHODS
Medical intensive care unit of a university hospital.


METHODS
Fifty-four mechanically ventilated patients (age, 63 +/- 16 yrs) were investigated via transthoracic echocardiography and Doppler. Main diagnoses were pneumonia (31%), acute exacerbation of chronic obstructive pulmonary disease (24%), congestive heart failure (11%), and poisoning (11%).


METHODS
Doppler examinations were performed simultaneously with measurements of pulmonary artery occlusion pressure via a right heart catheter.


RESULTS
Pulmonary artery occlusion pressure correlated with transmitral peak E-wave velocity (r =.46) and E/A ratio (r =.55). Pulmonary artery occlusion pressure inversely correlated with deceleration time of the transmitral E-wave (r = -.52), pulmonary venous peak S-wave velocity (r = -.37), and systolic fraction of the pulmonary forward flow (r = -.56). An E/A ratio >2 predicted a pulmonary artery occlusion pressure >18 mm Hg with a positive predictive value of 100%. A duration of pulmonary venous A-wave reversal flow exceeding the duration of the transmitral A-wave forward flow predicted a pulmonary artery occlusion pressure >15 mm Hg with a positive predictive value of 83%. A systolic fraction of the pulmonary venous forward flow <0.4 predicted a pulmonary artery occlusion pressure >12 mm Hg with a positive predictive value of 100%.


CONCLUSIONS
Transmitral and pulmonary venous flow patterns measured by transthoracic Doppler echocardiography can be used to estimate the left ventricular filling pressure in critically ill patients.
Boussuges
Alain
A
Service de Réanimation Médicale, CHU Sainte Marguerite, Marseille, France.
Blanc
Philippe
P
Molenat
Florence
F
Burnet
Henri
H
Habib
Gilbert
G
Sainty
Jean-Marie
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D018709:Statistics, Nonparametric; D016277:Ventricular Function, Left; D017725:Ventricular Pressure