Noninvasive measurement of left ventricular filling pressures by means of transmitral pulsed Doppler ultrasound

Abstract

In 54 consecutive patients, ages 59 ± 11 years, the transmitral diastolic flow velocity profile was derived by means of pulsed Doppler echocardiography simultaneously with right-sided heart catheterization. In 30 of them, ages 57 ± 10 years, left-sided heart catheterization was performed at the same time. The sample volume was positioned exactly in the mitral anulus plane, bisecting the anulus. The ratio of the time-velocity integrals of the A wave (atrial contraction) and E wave (early filling) was calculated ( A E ratio of integrals). Linear regression analysis showed a highly significant linear correlation of the A E ratio of integrate with regard to left ventricular (LV) end-diastolic pressure (r = 0.98, p < 0.001) and pulmonary capillary wedge pressure (r = 0.98, p < 0.001). The A E ratio of integrals also correlated with other hemodynamic parameters, such as cardiac output (r = −0.73, p < 0.001), cardiac index (r = −0.74, p < 0.001) and stroke volume index (r = −0.65, p < 0.001). For 19 additional patients, ages 55 ± 8 years, the values of LV end-diastolic pressure and pulmonary capillary wedge pressure were calculated by means of the corresponding formulas from the first data set. The correlation between the calculated and invasively measured LV filling pressures expressed in terms of intraclass correlation coefficients shows highly significant correlations for both LV end-diastolic pressure (intraclass correlation coefficient = 0.99, p < 0.001) and pulmonary capillary wedge pressure (intraclass correlation coefficient = 0.99, p < 0.001). The interobserver agreement concerning the A E ratio was almost perfect (intraclass correlation coefficient = 0.99, p < 0.001). Thus, LV filling parameters obtained by means of transmitral pulsed Doppler echocardiography provide a reliable noninvasive measurement of LV end-diastolic pressure and pulmonary capillary wedge pressure.