Shortened Doppler-derived mitral A wave deceleration time: An important predictor of elevated left ventricular filling pressure

Abstract

Objectives. The aim of this study was to investigate whether a new variable of mitral inflow, A wave deceleration time, identifies patients with elevated left ventricular filling pressures.Background. In patients with an elevated left ventricular end-diastolic pressure, the increase in left ventricular pressure after atrial contraction rapidly exceeds left atrial pressure, resulting in abrupt cessation of the A wave. Therefore, we postulated that a shortening of A wave deceleration time might be a marker for elevated end-diastolic pressure.Methods. Adequate pulsed Doppler mitral inflow velocities could be recorded in 40 of 44 consecutive patients undergoing cardiac catheterization simultaneosly with capillary wedge pressure in 20 patients, and within 1 h after left ventricular end-diastolic pressure recording in 20. Fifteen healthy volunteers were also studied.Results. Left ventricular end-diastolic pressure was 8 to 35 mm Hg, and mean pulmonary wedge pressure was 6 to 37 mm Hg. Close correlations were found between A wave deceleration time and mean pulmonary wedge pressure (r = −0.87) and left ventricular end-diastolic pressure (r = −0.74). There were modest correlations between both pressures and peak E/A, E wave deceleration time and A wave duration, respectively: r = 0.59, −0.30 and −0.58 for capillary wedge and r = 0.25, −0.38 and −0.49 for end-diastolic pressures. A wave deceleration time ≤60 ms predicted left ventricular end-diastolic and mean pulmonary wedge pressures > 18 mm Hg, respectively, with a sensitivity of 67% and 89% and specificity of 100% for both.Conclusions. A shortened Doppler mitral inflow A wave deceleration time is a useful index of elevated left ventricular filling pressure.