Noninvasive estimation of pulmonary capillary wedge pressure by color M-mode Doppler echocardiography in patients with acute myocardial infarction.

Abstract

The peak early diastolic filling velocity/flow propagation velocity (E/FPV) by color M-mode Doppler provides a better estimate of pulmonary capillary wedge pressure (PCWP) than transmitral or pulmonary venous flow. However, the value of E/FPV for the assessment of PCWP has not been evaluated in patients with acute myocardial infarction. We investigated the correlation between E/FPV and PCWP and whether PCWP can be estimated from E/FPV in patients with acute myocardial infarction. One hundred and two patients with acute myocardial infarction were divided into two groups. The first 60 patients were used to generate an equation to estimate PCWP (retrospective group). This equation was then assessed prospectively in the remaining 42 patients (prospective group). We measured the transmitral flow velocity indices and the deceleration time of diastolic pulmonary venous flow and E/FPV by Doppler echocardiography and compared these variables with PCWP measured using a pulmonary artery catheter. E/FPV was strongly correlated with PCWP (r = 0.89) in the retrospective group. The sensitivity of an E/FPV of > or = 2.0 for predicting a PCWP of > or = 18 mmHg was 95%, and the specificity was 98%. The estimated PCWP showed a strong correlation with the measured PCWP (r = 0.84, P < 0.0001) in the prospective group. The mean difference between the measured and estimated PCWP was - 0.4 +/- 3.6 mmHg. In patients with acute myocardial infarction, E/FPV by color M-mode Doppler during early left ventricular filling provides a better estimate of PCWP than transmitral or pulmonary venous flow.