Left Ventricular Diastolic Pressures Estimation by Echo-Doppler

pp 187-198

Abstract

Background

Transmitral flow is influenced by multiple factors, as left ventricular diastolic pressure and atrial pressure. When mitral flow pattern is normal the pulmonary venous record can be useful to detect intra cavitary pressure increased.

Objective

To estimate left ventricular diastolic pressures byecho Doppler.

Material and method

We studied prospectively 28 patients, 5 female and 23 male (age average 59 ± 10 years) with ischemic heart disease (26 patients), aortic stenosis (1 patient), and dilated cardiomyopathy (1 patient), with good record of pulmonary venous. All the patients were examined with echo 2D ± Doppler and after-wards, within the first hour in 26 cases and within the first 24 hours in 2 cases, a cardiac catheterization was done to them. We measured systolic fraction of pulmonary venous, A wave duration in pulmonary venous, difference between A wave du-ration in pulmonary venous and A wave of mitral flow (d),E/A radio in the echo-Doppler and with catheterization A wave amplitude (A), end diastolic pressure and pre-A pressure.

Results

A wave duration in pulmonary venous correlated with pre-A (r = 0.55; p < 0.01), A (4 = 0.53; p < 0.01) and end diastolic pressure (r = 0.65; p < 0.0001); systolic fraction of pulmonary venous with pre-A (r = -0.48; p < 0.05) and end diastolic pressure (r =-0.41; p < 0.05); d with A (r = 0.38; p < 0.05) and end diastolic pressure (r = 0.43; p < 0.05) and E/A with pre-A (r = 0.52; p < 0.01), A (r = 0.38; p < 0.05) and end diastolic pressure (r = 0.43; p < 0.05). Systolic fraction of pulmonary venous higher than 40% had 71% of sensivity, 83% of specificity, 62% positive predictive value and 88% negative predictive value to estimate increased pre-A pressure (more than 10mmHg). In 8 patients with normal E/A(1-1.5), ad higher than 20 m sec separate those with end diastolic pressure 5 12 mmHg (7 patients) and those with end diastolic pressure > 12 mmHg (1 patient) without false positives or negatives.

Conclusions

1) End diastolic pressure correlated with greater duration of A wave duration in pulmonary venous and increased d. 2) Systolic fraction of pulmonary venous had inverse correlation with pre-A and end diastolic pressure, whereas E/A ratio had positive correlation. 3) "Pseudo normalizated" transmitral flow can be detected with d. 4) The combination of trans mitral flow with pulmonary venous flow can be useful to estimate intraventricular diastolic pressure with acceptable sensitivity and specificity for a noninvasive technique.