title: Noninvasive estimation of left atrial pressure with transesophageal echocardiography.
abstract: BACKGROUND
  The pulmonary artery catheter (PAC) has historically been used to measure cardiac filling pressures of which pulmonary capillary wedge pressure (PCWP) has been used as a surrogate of left atrial pressure (LAP) and left ventricular end-diastolic pressure. Increasingly, the use of the PAC has been questioned in the perioperative period with multiple large studies unable to clearly demonstrate benefit in any group of patients, resulting in a declining use in the perioperative period. Alternative methods for the noninvasive estimation of left-sided filling pressures are required. Echocardiography has been used to provide noninvasive estimation of PCWP and LAP, based on evaluating mitral inflow velocity with the E and A waves and looking at movement of the mitral annulus with tissue Doppler (e').
  
  
  OBJECTIVE
  The aim of our study was to assess the relationship between PCWP and E/e' in cardiac surgical patients with transesophageal echocardiography (TOE).
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  Cardiac surgical patients in a single quaternary referral university teaching hospital.
  
  
  METHODS
  The ratio of mitral inflow velocity (E wave) to mitral annular tissue velocity (e') (the E/e' ratio) and PCWP of 91 patients undergoing general anesthesia and cardiac surgery were simultaneously recorded, with the use of TOE and a PAC.
  
  
  RESULTS
  The correlation between E/e' and PCWP was modest with a Spearman rank correlation coefficient of 0.29 (P = 0.005). The area under the receiver operating characteristic curve for using E/e' to predict elevated PCWP (≥18 mmHg) was 0.6825 (95% confidence interval: 0.57-0.80), indicating some predictive utility. The optimum threshold value of E/e' was 10 which had 71% sensitivity and 60% specificity to predict a PCWP ≥18 mmHg.
  
  
  CONCLUSIONS
  Noninvasive measurements of E/e' in general cardiac surgical patients have only a modest correlation and does not reliably estimate PCWP.
authors.affiliation: Department of Anesthesia, St. Vincent's Hospital, Melbourne, Australia; Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Cowie
authors.forename: Roman
authors.initials: R
authors.lastname: Kluger
authors.forename: Steffen
authors.initials: S
authors.lastname: Rex
authors.forename: Carlo
authors.initials: C
authors.lastname: Missant
mesh_terms: D000368:Aged; D062185:Atrial Pressure / Q000502:physiology*; D006348:Cardiac Surgical Procedures; D017548:Echocardiography, Transesophageal; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*