Noninvasive echocardiographic estimation of pulmonary wedge pressure in candidates for and recipients of heart transplantation.
OBJECTIVE
We assessed the value of deceleration time (dt) of diastolic wave of pulmonary venous flow (PVF) (PVF_dt) as noninvasive estimation of pulmonary wedge pressure (PWP) in candidates for and recipients of heart transplantation.


METHODS
We prospectively recruited 51 patients with end-stage congestive heart failure (group A) and 49 recipients of heart transplantation (group B). PWP and PVF_dt were measured using a Swan-Ganz catheter and Doppler echocardiography, respectively. We performed regression analyses to assess interrelationships. Moreover, we used the area under the receiver operating characteristic curve to assess how clearly PVF_dt could discriminate between normal and elevated PWP values.


RESULTS
In both study groups, PWP was inversely associated with PVF_dt (R(2) = 0.785 and 0.797, respectively, P < .001). A cut-off value of less than 187 milliseconds was predictive of an elevated PWP value (> or =12 mm Hg) in both study groups. Specificity and sensitivity were between 90% and 100%, respectively, in both study groups. The area under the receiver operating characteristic curve was 0.961 (0.908-1.013; P < .001) for group A and 0.998 (0.992-1.04; P < .001) for group B.


CONCLUSIONS
In recipients of heart transplantation and patients with end-stage congestive heart failure, the noninvasive measuring of PVF_dt distinguishes between normal and elevated PWP values.
Tenderich
Gero
G
Department of Cardio-Thoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Bad Oeynhausen, Germany. gtenderich@hdz-nrw.de <gtenderich@hdz-nrw.de>
Olariu
Adriana
A
Zittermann
Armin
A
Wellnhofer
Ernst
E
Koertke
Heinrich
H
Koerfer
Reiner
R
D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012372:ROC Curve; D012720:Severity of Illness Index