Pulmonary venous flow determinants of left atrial pressure under different loading conditions in a chronic animal model with mitral regurgitation

Abstract

Background: The aim of our study was to quantitatively compare the changes and correlations between pulmonary venous flow variables and mean left atrial pressure (mLAP) under different loading conditions in animals with chronic mitral regurgitation (MR) and without MR. Methods: A total of 85 hemodynamic conditions were studied in 22 sheep, 12 without MR as control (NO-MR group) and 10 with MR (MR group). We obtained pulmonary venous flow systolic velocity (Sv) and diastolic velocity (Dv), Sv and Dv time integrals, their ratios (Sv/Dv and Sv/Dv time integral), mLAP, left ventricular end-diastolic pressure, and MR stroke volume. We also measured left atrial a, x, v, and y pressures and calculated the difference between v and y pressures. Results: Average MR stroke volume was 10.6 ± 4.3 mL/beat. There were good correlations between Sv ( r = −0.64 and r = −0.59, P < .01), Sv/Dv ( r = −0.62 and r = −0.74, P < .01), and mLAP in the MR and NO-MR groups, respectively. Correlations were also observed between Dv time integral ( r = 0.61 and r = 0.57, P < .01) and left ventricular end-diastolic pressure in the MR and NO-MR groups. In velocity variables, Sv ( r = −0.79, P < .001) was the best predictor of mLAP in both groups. The sensitivity and specificity of Sv = 0 in predicting mLAP 15 mm Hg or greater were 86% and 85%, respectively. Conclusion: Pulmonary venous flow variables correlated well with mLAP under altered loading conditions in the MR and NO-MR groups. They may be applied clinically as substitutes for invasively acquired indexes of mLAP to assess left atrial and left ventricular functional status. (J Am Soc Echocardiogr 2002;15:1181-8.)