Tissue Doppler imaging estimation of pulmonary artery occlusion pressure in ICU patients.
OBJECTIVE
Earlier reports suggested that transthoracic (TTE) determination of the ratio of mitral inflow E wave velocity to early diastolic mitral annulus velocity (E/E') measured by tissue Doppler imaging (TDI) closely approximates PAOP in cardiac patients. However, the value of E/E' for PAOP assessment in ICU patients has not been evaluated. This study assessed whether the E/E' ratio provides an accurate estimation of pulmonary artery occlusion pressure (PAOP) in mechanically ventilated ICU patients.


METHODS
Prospective, open, clinical study in the ICU of a university hospital.


METHODS
Twenty-three consecutive mechanically ventilated patients.


METHODS
Volume expansion in 14 patients.


RESULTS
Doppler TTE or TEE mitral inflow and TDI mitral annulus velocities were determined and compared with PAOP measured using a Swan-Ganz catheter. Of all the Doppler variables studied the best correlations were observed between PAOP and the lateral (r=0.84) and medial (r=0.76) annulus E/E' ratio and remained highly significant when the analysis was restricted to TEE (r=0.91 and 0.86) or TTE (r=0.73 and 0.61). The sensitivities and specificities of estimating PAOP at 15 mmHg or higher were, respectively, 86% and 81% for lateral E/E' above 7.5 and 76% and 80% for medial E/E' above 9. PAOP changes after volume expansion (700+/-230 ml) were limited and accurately assessed by repeated E/E' determinations.


CONCLUSIONS
In mechanically ventilated ICU patients TTE or TEE E/E' determinations using TDI closely approximate PAOP.
Combes
Alain
A
Réanimation Médicale,Institut de Cardiologie, AP-HP, Hôpital Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France. alain.combes@psl.ap-hop-paris.fr
Arnoult
Florence
F
Trouillet
Jean-Louis
JL
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D003422:Critical Care / Q000379:methods / Q000592:standards; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D015150:Echocardiography, Doppler / Q000379:methods / Q000592:standards*; D017548:Echocardiography, Transesophageal / Q000379:methods / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity; D016037:Single-Blind Method