A left atrial minimal volume > 40 cm3 identified a mean pulmonary wedge pressure > 12 mm Hg with 82% sensitivity and 98% specificity in patients with coronary artery disease.
Cross-Sectional (n=70)
Can echocardiographic left atrial size and Doppler flow variables accurately estimate left ventricular filling pressures in patients with coronary artery disease?
Left atrial size and ejection fraction, along with Doppler flow variables, provide independent and accurate non-invasive estimates of left ventricular filling pressures in patients with coronary artery disease.
Effect estimate: r = 0.72
OBJECTIVES: The purpose of this study was to determine whether left atrial size and ejection fraction are related to left ventricular filling pressures in patients with coronary artery disease. BACKGROUND: In patients with coronary artery disease, left ventricular filling pressures can be estimated by using Doppler mitral and pulmonary venous flow velocity variables. However, because these flow velocities are age dependent, additional variables that indicate elevated left ventricular filling pressures are needed to increase diagnostic accuracy. METHODS: Echocardiographic left atrial and Doppler mitral and pulmonary venous flow velocity variables were correlated with left ventricular filling pressures in 70 patients undergoing cardiac catheterization. RESULTS: Left atrial size and volumes were larger and left atrial ejection fractions were lower in patients with elevated left ventricular filling pressures. Mean pulmonary wedge pressure was related to mitral E/A wave velocity ratio (r = 0.72), left atrial minimal volume (r = 0.70), left atrial ejection fraction (r = -0.66) and atrial filling fraction (r = -0.66). Left ventricular end-diastolic and A wave pressures were related to the difference in pulmonary venous and mitral A wave duration (both r = 0.77). By stepwise multilinear regression analysis, the ratio of mitral E to A wave velocity was the most important determinant of pulmonary wedge (r = 0.63) and left ventricular pre-A wave (r = 0.75) pressures, whereas the difference in pulmonary venous and mitral A wave duration was the most important variable for both left ventricular A wave (r = 0.75) and left ventricular end-diastolic (r = 0.80) pressures. The sensitivity of a left atrial minimal volume > 40 cm3 for identifying a mean pulmonary wedge pressure > 12 mm Hg was 82%, with a specificity of 98%. CONCLUSIONS: Left atrial size, left atrial ejection fraction and the difference between mitral and pulmonary venous flow duration at atrial contraction are independent determinants of left ventricular filling pressures in patients with coronary artery disease. The additive value of left atrial size and Doppler variables in estimating filling pressures and the possibility that left atrial size may be less age dependent than other mitral and pulmonary venous flow velocity variables merit further investigation.
Appleton et al. (Wed,) conducted a cross-sectional in Coronary artery disease (n=70). Echocardiographic left atrial and Doppler flow velocity variables vs. Invasive left ventricular filling pressures was evaluated on Correlation of echocardiographic variables with left ventricular filling pressures (r = 0.72). A left atrial minimal volume > 40 cm3 identified a mean pulmonary wedge pressure > 12 mm Hg with 82% sensitivity and 98% specificity in patients with coronary artery disease.