Tissue Doppler echocardiographic and color M-mode estimation of left atrial pressure in infants.
OBJECTIVE
Using recorded flow and tissue Doppler, we evaluated the relation of peak velocity of early transmitral Doppler filling (E)/early diastolic velocity of the lateral mitral annulus (Ea) ratio and of E/flow propagation velocity (Vp) ratio to mean left atrial pressure in infants after surgery for congenital heart disease.


METHODS
Experimental design.


METHODS
Pediatric intensive care unit.


METHODS
Thirty-seven infants aged 4 (3-8) months.


METHODS
Patients underwent postoperative invasive hemodynamic monitoring with simultaneously obtained Doppler measurements.


RESULTS
Values are expressed as median (25th-75th percentiles). Heart rate was 145 (135-157) beats/min. Left atrial pressure was 10 (8-12) mm Hg with E/Ea 16 (12-19) and E/Vp 1.9 (1.3-2.4). E/Ea and E/Vp ratios were higher in patients with left atrial pressure >10 mm Hg (n = 18), than in patients with left atrial pressure < or =10 mm Hg (n = 19) (E/Ea, 16 [15-25] vs. 12 [9-17], p = .01; E/Vp, 2.3 [1.9-2.8] vs. 1.4 [1-1.9]. respectively, p = .001). At a cutoff point of 15, E/Ea sensitivity for left atrial pressure >10 mm Hg was 17 of 18 (94%) with specificity 13 of 18 (72%). At a cutoff point of 2, E/Vp sensitivity for left atrial pressure >10 mm Hg was 15 of 18 (83%) with specificity 16 of 18 (89%). Areas under the receiver operating characteristic curves were 0.76 (E/Ea) and 0.83 (E/Vp).


CONCLUSIONS
Doppler ratios might be considered as promising noninvasive tools for left atrial pressure evaluation in infants after cardiac surgery.
Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
Fabrice
F
Larrazet
Kamel
K
Bouabdallah
Emmanuel
E
Le Bret
Pascal
P
Vouhé
Colette
C
Veyrat
François
F
Laborde
D001783:Blood Flow Velocity; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods*; D006328:Cardiac Catheterization / Q000009:adverse effects; D003971:Diastole; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006325:Heart Atria; D006330:Heart Defects, Congenital / Q000601:surgery*; D006343:Heart Septal Defects / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D015588:Observer Variation; D011182:Postoperative Care; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity