title: Interatrial septum motion but not Doppler assessment predicts elevated pulmonary capillary wedge pressure in patients undergoing cardiac surgery.
abstract: BACKGROUND
  Left atrial pressure and its surrogate, pulmonary capillary wedge pressure (PCWP), are important for determining diastolic function. The role of transthoracic echocardiography (TTE) in assessing diastolic function is well established in awake subjects. The objective was to assess the accuracy of predicting PCWP by TTE and transesophageal echocardiography (TEE) during coronary artery surgery.
  
  
  METHODS
  In 27 adult patients undergoing on-pump coronary artery surgery, simultaneous echocardiographic and hemodynamic measurements were obtained immediately before anesthesia (TTE), after anesthesia and mechanical ventilation (TTE and TEE), during conduit harvest (TEE), and after separation from cardiopulmonary bypass (TEE).
  
  
  RESULTS
  Twenty patients had an ejection fraction (EF) of 0.5 or greater. With the exception of E/e' and S/D ratios, echocardiographic values changed over the echocardiographic studies. In patients with low EF, E velocity, deceleration time, pulmonary vein D, S/D, and E/e' ratios correlated well with PCWP before anesthesia. After induction of anesthesia using TTE or TEE, correlations were poor. In normal EF patients, correlations were poor for both TEE and TTE at all five stages. The sensitivity and specificity of echocardiographic values were not high enough to predict raised PCWP except for a fixed curve pattern of interatrial septum (area under the curve 0.89 for PCWP ≥ 17, and 0.98 for ≥ 18 mmHg) and S/D less than 1 (area under the curve 0.74 for PCWP ≥ 17, and 0.78 for ≥ 18 mmHg).
  
  
  CONCLUSIONS
  Doppler assessment of PCWP was neither sensitive nor specific enough to be clinically useful in anesthetized patients with mechanical ventilation. The fixed curve pattern of the interatrial septum was the best predictor of raised PCWP.
authors.affiliation: From the Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia (D.L.H., M.M.A., A.R., D.J.C., C.F.R.); and The Statistical Consulting Centre, The University of Melbourne, Melbourne, Australia (S.C.).
authors.forename: Darsim L
authors.initials: DL
authors.lastname: Haji
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Ali
authors.forename: Alistair
authors.initials: A
authors.lastname: Royse
authors.forename: David J
authors.initials: DJ
authors.lastname: Canty
authors.forename: Sandy
authors.initials: S
authors.lastname: Clarke
authors.forename: Colin F
authors.initials: CF
authors.lastname: Royse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054087:Atrial Septum / Q000000981:diagnostic imaging* / Q000502:physiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology