title: Abnormal septal motion affects early diastolic velocities at the septal and lateral mitral annulus, and impacts on estimation of the pulmonary capillary wedge pressure.
abstract: Abnormal motion of the interventricular septum (ASM), seen post cardiac operation, with left bundle branch block or right ventricular pacing, may affect septal mitral annular motion and correlation of the ratio between the velocity of early diastolic mitral inflow and the early diastolic mitral annular velocity (E/Ea) with pulmonary capillary wedge pressure (PCWP). We examined the effect of ASM on the relationship between E/Ea and E/Vp (propagation velocity of mitral inflow) ratios and PCWP in adult patients in the intensive care unit (14 with normal septal motion [NSM], 36 with ASM) undergoing echocardiography and pulmonary artery catheterization. E/Ea correlated well with PCWP during NSM ( r = 0.86 lateral annulus, r = 0.75 septal annulus), but poorly during ASM ( r = 0.36 lateral annulus, r = 0.39 septal annulus). E/Vp correlated poorly with PCWP ( r = 0.05 NSM, r = 0.17 ASM). For patients who are critically ill, E/Vp ratios poorly estimate PCWP. During NSM, E/Ea ratios measured at the lateral or septal annulus correlate well with PCWP. ASM affects E/Ea ratios at both the septal and lateral annulus, making E/Ea ratios unreliable for estimating PCWP in this group.
authors.affiliation: Department of Cardiology, St Vincent's Hospital, Fitzroy, Victoria, Australia.
authors.forename: Karen Adele
authors.initials: KA
authors.lastname: D'Souza
authors.forename: Donald John
authors.initials: DJ
authors.lastname: Mooney
authors.forename: Andrew Edyvane
authors.initials: AE
authors.lastname: Russell
authors.forename: Andrew Ian
authors.initials: AI
authors.lastname: MacIsaac
authors.forename: Philip Edmund
authors.initials: PE
authors.lastname: Aylward
authors.forename: David Lloyd
authors.initials: DL
authors.lastname: Prior
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology*; D009200:Myocardial Contraction; D011669:Pulmonary Wedge Pressure