Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Left ventricular filling pattern and pulmonary wedge pressure are closely related in patients with recent anterior myocardial infarction and left ventricular dysfunction
Divisione di Cardiologia, Centro Medico di Montescano, Fondazione Clinica del Lavoro IRCCS, Pavia, Italy
Received 5 August 1991; revised 17 December 1991; .
Correspondence. Masimo Pozzoli, MD, Divisione di Cardiologia, Centro Medico, 27040 Monlcscano (Pavia), Italy.
Abstract
To determine whether mitral flow velocity can be used to estimate mean pulmonary wedge pressure (PWP) in patients with left ventricular dysfunction, 50 patients with recent Q-wave anterior infarction and a reduced ejection fraction ( < 40% ) underwent simultaneous pulsed-wave Doppler measurements of mitral flow and right heart catheterization. Doppler tracings and PWP were recorded at rest, after passive leg lifting (45°) and (in 15 patients with increased PWP) after 5 mg sublingual ISDN.
Significant correlations were found between the ratio of peak early to peak late diastolic velocity (EjA) and PWP (r = 0.83). Early diastolic deceleration and the ratio of the time velocity integral of atrial contribution to the total time velocity integral were also correlated to PWP (r 0.80 and r = 0.79 (respectively). The E/A ratio was less than 1 in 25 patients and more than 1 in the remaining 25. An E/A ratio of at least 1 predicted a PWP of more than 20 mmHg with a sensitivity of 100% and a specificity of 86%. In all five patients, in whom the P WP was less than 20 mmHg at baseline and became greater with leg lifting, the E/A ratio changed from less than 1 to more than L After ISDN, changes in E/A ratio from more than 1 to less than 1 identified all 12 patients with a PWP falling below 20 mmHg.
In conclusion, patients with recent Q-wave anterior infarction and a reduced ejection fraction mitral flow velocity-derived variables correlate with PWP representing a reliable index for the diagnosis of markedly increased PWP. In individual patients, Doppler measurement of mitral flow can predict directional changes of PWP and may provide a simple non-invasive means of assessing the haemodynamic effect of therapeutic interventions.
Key Words: Doppler echocardiography • mitral flow velocity • pulmonary wedge pressure • anterior myocardial infarction
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