title: Accuracy of noninvasive estimation of pulmonary wedge pressure by echocardiographic indices in heart transplant recipients.
abstract: BACKGROUND
  Pulmonary capillary wedge pressure (PCWP) can be estimated from transmitral or color M-mode Doppler flow propagation velocities. However, it has been recommended to not use these indices in heart transplant recipients. Our aim was to compare the accuracy of color M-mode, Doppler, and Doppler tissue imaging (DTI)-derived indices to predict PCWP in heart transplant recipients.
  
  
  METHODS
  We studied 50 consecutive heart transplant recipients scheduled for routine right-sided heart catheterization and endomyocardial biopsy. Their mean age was 49 ± 17 years and the mean time after heart transplantation was 29 ± 41 months. An echocardiogram was performed immediately after the invasive procedure. We analysed PCWP, transmitral flow velocity variables (peak velocity during early filling (E) and deceleration time [DT]), color M-mode Doppler flow propagation velocity (Vp), and mitral annulus peak early diastolic velocity (E') from DTI. Doppler estimated-PCWP (ePCWP) was calculated as follows: (5.27 × E/Vp) + 4.6.
  
  
  RESULTS
  Mean ejection fraction was 66 ± 11%. The mean invasive measured PCWP was 11.14 ± 5.4 mm Hg and the mean noninvasive ePCWP was 11.13 ± 1.8 mm Hg (r = 0.66; P < .0001). A good correlation was present between invasive PCWP and mitral PW-Doppler and DTI parameters: peak E 91 ± 22 cm/s (r = 0.34; P = .02) and DT 143 ± 26 s (r = -0.436; P = .002), E/E' ratio medial mitral annulus 10 ± 4 cm/s (r = 0.353; P = .026) and E/E' ratio lateral mitral annulus 6 ± 2 cm/s (r = 0.462; P = .002). E/Vp was the most accurate index for predicting PCWP (r = 0.615; P < .0001).
  
  
  CONCLUSIONS
  Compared with other indirect Doppler indices, E/Vp showed the best correlation to predict PCWP in heart transplant recipients. Despite previous recommendations, PCWP can be accurately estimated from color M-mode indices, giving useful information and avoiding the risks of invasive measurements.
authors.affiliation: 12 Octubre University Hospital, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: López
authors.forename: V
authors.initials: V
authors.lastname: Sanchez
authors.forename: J F
authors.initials: JF
authors.lastname: Delgado
authors.forename: S F
authors.initials: SF
authors.lastname: Casares
authors.forename: L
authors.initials: L
authors.lastname: Mora
authors.forename: J
authors.initials: J
authors.lastname: García
authors.forename: F
authors.initials: F
authors.lastname: Lombera
authors.forename: A
authors.initials: A
authors.lastname: Forteza
authors.forename: J M
authors.initials: JM
authors.lastname: Cortina
authors.forename: C
authors.initials: C
authors.lastname: Saenz de la Calzada
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D018618:Echocardiography, Doppler, Color; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D006321:Heart / Q000503:physiopathology*; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left