Left ventricular filling pattern and pulmonary wedge pressure are closely related in patients with recent anterior myocardial infarction and left ventricular dysfunction

Pozzoli, Massimo; Capomolla, Soccorso; Opasich, C.; Reggiani, R; Calsamiglia, Giuseppe; Cobelli, Franco; Tavazzi, Luigi

doi:10.1093/oxfordjournals.eurheartj.a060315

Cited by 22 publications

(10 citation statements)

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“…We also found significant positive correlation of PCWP with deceleration rate (rs0.651), but did not find any correlation of PCWP with two other parameters (rs0.066 and rs0.224) for the E/A ratio and peak A-wave, respectively. One study showed a significant positive correlation between PCWP and E/A ratio (rs0.83) and early diastolic deceleration rate (rs0.80) (18). In addition, that study also established an inverse relation between mean PCWP and mitral flow velocity at atrial contraction, A-wave (rs0.66).…”

Section: Discussionmentioning

confidence: 82%

Pulmonary capillary wedge pressure estimation by Doppler echocardiography and cardiac catheterization: a study at a tertiary level hospital in Bangladesh

Tamanna

Jahan

Nahar

et al. 2010

International Journal on Disability and Human Development

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Background: Doppler echocardiography is a valuable tool for the non-invasive evaluation of diastolic function. This study aimed to correlate the pulmonary capillary wedge pressure (PCWP) estimated by Doppler echocardiography. Methods: Fifty patients with coronary artery disease (unstable angina, acute and previous myocardial infarction) subjected to diagnostic cardiac catheterization for evaluations were studied during the period of January 2002 to December 2002 in the Department of Cardiology at the National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. Results: For the 2D and M mode echocardiographic indices, the ejection fraction was significantly lower and maximal left atrial volume was significantly higher in patients having PCWP G18 mm Hg (p-0.05). For Doppler-derived mitral flow, the deceleration rate was significantly higher (p-0.05) in patients having PCWP G18 mm Hg. Statistically significant negative correlation of deceleration time (rs-0.483; ps0.001) and ejection fraction (rs-0.334; ps0.01) and statistically significant positive correlation of peak E wave (rs0.345; ps0.01) and deceleration rate (rs0.651; ps0.001) was found with catheter-derived PCWP. Conclusions: Doppler echocardiography is a simple, repeatable, readily available, non-invasive tool which could reduce the need for right heart catheterization and might provide us with a bedside method of estimating and monitoring PCWP.

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Section: Discussionmentioning

confidence: 82%

Pulmonary capillary wedge pressure estimation by Doppler echocardiography and cardiac catheterization: a study at a tertiary level hospital in Bangladesh

Tamanna

Jahan

Nahar

et al. 2010

International Journal on Disability and Human Development

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“…Another study 19 showed significant positive correlation between PCWP and E/A ratio (r=0.83) and early diastolic deceleration rate (r=0.80). In addition, that study also established an inverse relation between mean PCWP and mitral flow velocity at atrial contraction, A-wave (r=0.66).…”

Section: Resultsmentioning

confidence: 89%

Correlation of Doppler echocardiography with cardiac catheterization in estimating pulmonary capillary wedge pressure: A tertiary level hospital finding in Bangladesh

et al. 2009

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IntroductionPulmonary Capillary Wedge Pressure (PCWP) is an established index of cardiac function and an essential component in the management of patients with congestive heart failure and in critically ill patients. It provides the haemodynamic status in patients with acute myocardial infarction. Several Doppler echocardiographic assessments of haemodynamic variables in patients with advanced heart failure are accurate and reproducible. This noninvasive methodology may assist with monitoring and optimizing medical therapy in such patients. At present echocardiography is the most useful and widespread tool used in heart failure patients with regard to diagnosis, assessment and haemodynamic characterization 1-3 . Mitral Doppler echocardiography provides a simple and noninvasive method of estimating and monitoring PCWP in patients with severe left ventricular systolic dysfunction 3 . Although all mitral Doppler variables were independent predictor of PCWP, among mitral flow velocity indexes deceleration rate showed strongest correlation with PCWP followed by E/A ratio and deceleration time 4 .Several studies using both transoesophageal and transthoracic Doppler echocardiography have found close correlation between pulmonary venous flow variables and left ventricular filling pressures, suggesting that these variables may be more accurate predictorof filling pressure than are mitral flow variables [5][6][7] .Within pulmonary venous flow indices systolic fraction of peak velocities showed University Heart Journal Vol. AbstractThis prospective cross sectional study was conducted in the department of cardiology in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of January 2002 to December 2002. A total of 50 patients with coronary artery disease subjected to diagnostic cardiac catheterization for evaluation of CAD were studied and the patients were grouped into two groups, group I having PCWP ≥12-<18 mmHg and group II having PCWP ≥18 mmHg. The aims of the study were to correlate the Pulmonary Capillary Wedge Pressure (PCWP) estimated by Doppler echocardiography with that obtained at cardiac catheterization. Among 2D and M mode echocardiographic indices it was observed that ejection fraction was significantly lower and maximal left atrial volume (MLAV) was significantly higher among patients having PCWP ≥18 mmHg (p<0.05). Among Doppler derived mitral flow variables deceleration rate was significantly higher (p<0.05) among patients having PCWP ≥18 mmHg. No statistically significant difference was found between two groups in terms of pulmonary venous flow variables. A statistically significant negative correlation of deceleration time (r=-0.483; p=0.001) and ejection fraction (r=-0.334; p=0.01) and a statistically significant positive correlation of peak E wave (r=0.345; p=0.01) and deceleration rate (r=0.651; p=0.001) was found with catheter derived PCWP. The correlation coefficient between measured and estimated PCWP (from equation 1) was (r=0.678) which was highest. When pulmonary ven...

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“…In patients with idiopathic cardiac disease a shift of How towards late diastole, associated with a decrease in left ventricular filling pressure, probably re flected a transition from 'restriction' to 'altered relax ation', or to 'pseudonormalization' [ 17], Flow shift is rea sonably interpretable as secondary to a reduction of peri cardial restraint [10] due to a decrease of venous return to the right heart after captopril [23] and possibly to ventric ular interdependence [24], This interpretation is support ed by the work of Pozzoli et al [19], in which a similar modification of the filling pattern was evidenced after preload reduction with isosorbide dinitrate, as well as by a work from our group [20], in which the venous return was impeded by vena cava balloon obstruction in patients with dilated cardiomyopathy. On the other hand, func tional class worsening [4,6] and progression of cardiac dysfunction [4,25,26] have been found to be associated with transition of the Doppler pattern from 'altered relax ation' to 'restriction'.…”

Section: Left V Entricular Filling and Structurementioning

confidence: 93%

“…There is not a clear-cut sep aration between the two, mainly because they are quite sensitive to changes in load: in fact, when the ventricular filling pressure is raised the former may shift to the latter [17], and vice versa when the left ventricular preload is reduced [19,20]. A 'pseudonormalized" pattern has also been described (normal E/A ratio but shortened decelera tion time) [17], which reflects masking of impaired relax ation by an elevated filling pressure.…”

Section: Baseline Left Ventricular Fillingmentioning

confidence: 99%

Acute Filling Pattern Changes of the Failing Left Ventricle after Captopril as Related to Ventricular Structure

Barbier¹,

Tamborini²,

Alioto³

et al. 1996

Cardiology

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In congestive heart failure captopril modifies the left ventricular filling pattern mainly by unloading the heart. We investigated whether the structural characteristics of the left ventricle may influence the acute effects of captopril on this pattern in patients with untreated hypertensive (H group, 6 patients) or idiopathic (I group, 14 patients) cardiomyopathy. We evaluated changes of pulsed Doppler mitral flow, of systemic arterial and wedge pulmonary pressures 40 min after 25 mg captopril administered sublingually, and correlated these changes with the M-mode echocardiographic relative wall thickness index (h/r). Baseline mean arterial pressure (H = 137 ± 20 mm Hg, mean ± SD, I = 95 ± 19 mm Hg; p < 0.001), and h/r (H = 0.38 ± 0.03,1 = 0.28 ± 0.09; p < 0.05) were greater in the high blood pressure group; wedge pressure, echocardiographic biplane ejection fraction, and Doppler indexes of the left ventricular filling were similar in the two populations. After captopril, ejection fraction did not change significantly, mean arterial pressure decreased significantly in hypertensive patients (H group, baseline = 137 ± 20, captopril = 119 ± 10, p = 0.02; I group, baseline = 95 ± 19, captopril = 90 ± 24, p = nonsignificant), and the wedge pressure was reduced by the same extent in both groups (H group, baseline = 27.7 ± 3, captopril = 21 ± 7, p < 0.05; I group, baseline = 20 ± 12, captopril = 15 ± 8, p < 0.05). In the H group early mitral flow increased [(E wave integral) × (mitral annulus area)] by 38 ± 15%, and was almost steady in the I group (-1.3 ± 30%; group H vs. I = p < 0.01); late mitral flow [(A wave integral) × (mitral annulus area)] showed a pattern exactly opposite to this (H = +0.4 ± 40%, I = +38 ± 19; p < 0.01). In the whole population there was a significant correlation between the early /late flow ratio variations and baseline h/r (r = 0.6, p < 0.05). In chronic congestive heart failure, changes in left ventricular filling with captopril are related to h/r: a higher index, as recorded in the H group, is associated with ‘true normalization’ of the filling pattern after captopril; a lower index, as recorded in the I group, is associated with ‘pseudonormalization’ despite a similar decrease of left ventricular filling pressure.

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Left ventricular filling pattern and pulmonary wedge pressure are closely related in patients with recent anterior myocardial infarction and left ventricular dysfunction

Cited by 22 publications

References 0 publications

Pulmonary capillary wedge pressure estimation by Doppler echocardiography and cardiac catheterization: a study at a tertiary level hospital in Bangladesh

Pulmonary capillary wedge pressure estimation by Doppler echocardiography and cardiac catheterization: a study at a tertiary level hospital in Bangladesh

Correlation of Doppler echocardiography with cardiac catheterization in estimating pulmonary capillary wedge pressure: A tertiary level hospital finding in Bangladesh

Acute Filling Pattern Changes of the Failing Left Ventricle after Captopril as Related to Ventricular Structure

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