title: Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit.
abstract: 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.
authors.affiliation: Service de Réanimation Médicale, CHU Sainte Marguerite, Marseille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Boussuges
authors.forename: Philippe
authors.initials: P
authors.lastname: Blanc
authors.forename: Florence
authors.initials: F
authors.lastname: Molenat
authors.forename: Henri
authors.initials: H
authors.lastname: Burnet
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Sainty
mesh_terms: 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