Can Transthoracic Doppler Echocardiography Predict the Discrepancy Between Left Ventricular End-Diastolic Pressure and Mean Pulmonary Capillary Wedge Pressure in Patients With Heart Failure?

BACKGROUND: Left ventricular end-diastolic pressure (LVEDP) is difficult to measure continuously; therefore, pulmonary capillary wedge pressure (PCWP) is frequently used instead for hemodynamic monitoring in patients with heart failure. However, a discrepancy between LVEDP and mean PCWP is sometimes observed. METHODS AND RESULTS: To assess the feasibility of evaluating this discrepancy using echo-Doppler indexes, 140 consecutive patients with heart disease were studied. Transthoracic Doppler echocardiography (TTDE) was performed immediately before bilateral-sided cardiac catheterization. We measured peak velocities of early (E: cm/s) and late (A: cm/s) diastolic transmitral flow, and duration of A wave (MAd: ms). We also measured the duration of atrial reversal of pulmonary venous flow (PAd: ms). The difference between PAd and MAd (Deltad = PAd-MAd: ms) was calculated. The ratio of E to tissue Doppler-derived peak early diastolic velocity of mitral annulus (Ea: cm/s) was also calculated (E/Ea). There was a good positive correlation between LVEDP and Deltad (r = 0.77, p or = 10 ms and E/Ea or = 17 mmHg) and normal mean PCWP (< or = 12 mmHg) were predicted with 100% sensitivity and 85% specificity. CONCLUSIONS: Evaluation of the discrepancy between LVEDP and mean PCWP in patients with heart failure was feasible by separately estimating LVEDP by Deltad and mean PCWP by E/Ea using noninvasive TTDE. Early detection of patients with elevated LVEDP and normal mean PCWP may be useful for preventing acute exacerbation of chronic heart failure.