title: Left atrial inflow propagation rate: a new transesophageal echocardiographic index of preload.
abstract: We postulated that the rate of blood propagating into the left atrium from the left upper pulmonic vein would be a useful measure of pulmonary capillary wedge pressure (PCWP). In 23 adult patients who were critically ill (ie, study group) and receiving mechanical ventilation, color M-mode multiplane transesophageal echocardiography was used to measure left atrial inflow propagation rate (LAIF-PR) as a potential index of PCWP measured by right heart catheterization. LAIF-PR was measured in systole and diastole as the slope of the color M-mode signal entering the left atrium from the left upper pulmonic vein. Correlation with PCWP was good for systolic (r = -0.847, P < .0001) and diastolic (r = -0.78, P < .0001) LAIF-PR. The reliability of univariate linear regression equations derived from the study group was tested in 29 subsequent patients (ie, testing group). Measured PCWP was accurately estimated within 5 mm Hg in 85% (22 of 26 patients) and 68% (17 of 25 patients) of the testing group by systolic and diastolic LAIF-PR, respectively. Color M-mode transesophageal echocardiography-derived LAIF-PR, particularly in systole, is a promising new index to estimate PCWP in patients who are critically ill.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Louisville, KY 40202, USA. mfstod01@gwise.louisville.edu
authors.forename: Marcus F
authors.initials: MF
authors.lastname: Stoddard
authors.forename: Rita A
authors.initials: RA
authors.lastname: Longaker
authors.forename: Norberto
authors.initials: N
authors.lastname: Calzada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology*; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D015203:Reproducibility of Results