Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Effect of different loading conditions.

Abstract

It has previously been demonstrated that predictable changes occur in mitral flow velocities under different loading conditions. The purpose of this study was to relate changes in pulmonary venous and mitral flow velocities during different loading conditions as assessed by transesophageal echocardiography in the operating room. Nineteen patients had measurements of hemodynamics, that is, mitral and pulmonary vein flow velocities during the control situation, a decrease in preload by administration of nitroglycerin, an increase in preload by administration of fluids, and an increase in afterload by infusion of phenylephrine. There was a direct correlation between the changes in the mitral E velocity and the early peak diastolic velocity in the pulmonary vein curves (r=0.61) as well as a direct correlation between the deceleration time of the mitral and pulmonary venous flow velocities in early diastole (r=0.84).This indicates that diastolic flow velocity in the pulmonary vein is determined by the same factors that influence the mitral flow velocity curves. A decrease in preload caused a significant reduction in the initial E velocity and prolongation of deceleration time, and an increase in preload caused an increase in E velocity and shortening of deceleration time. An increase in afterload produced a variable effect on the initial E velocity and deceleration time and was dependent on the left ventricular filling pressure. The change in systolic forward flow velocity in the pulmonary vein was directly proportional to the change in cardiac output (r=0.60). The pulmonary capillary wedge pressure correlated best with the flow velocity reversal in the pulmonary vein at atrial contraction (r=0.81). Use of pulmonary vein velocities in conjunction with mitral flow velocities can help in understanding left ventricular filling. (Circulation 1990;81:1488-1497 Abnormalities of diastolic function of the heart play an integral role in many disease entities.'2 Because of the complexity of the multiple, interrelated processes contributing to diastolic function, there is no clinical tool available for its assessment.3 It has been proposed that Doppler echocardiography might provide information concerning diastole because of its ability to noninvasively measure blood flow velocities across the mitral valve.45 We, as well as others,6-9 previously demonstrated that predictable changes occur in the mitral flow velocities under different loading conditions. This has resulted in understanding the significance of changes in these velocities and has allowed the development of a conceptual framework for interpretation of the various velocity curves.'0 Pulmonary vein velocities have recently been used in conjunction with mitral flow velocities to increase our understanding of ventricular filling.11-13 However, because of the location of the pulmonary vein in the far field from a precordial apical window, it can be difficult to place the sample volume within the pulmonary vein to obtain the true velocities through the pulmonary vein. Th...

Echocardiographic evaluation of diastolic heart failure

“…Systolic forward flow is often biphasic with S1 related to atrial relaxation and LA pressure while S2 is related to stroke volume and propagation in the arterial tree 44 , 45 (S2 is used to derive S/D ratio). D velocity is influenced by LV filling and compliance and changes parallel to mitral E velocity 46 . AR velocity and duration are affected by LV late diastolic pressures, atrial preload and LA contractility 47 .…”

Left atrial inflow propagation rate derived by transesophageal color M‐mode echocardiography is a promising index of preload

“…However, several studies have investigated the relationship between PCWP and TEE-derived Doppler indices of pulmonic vein flow in patients receiving mechanical ventilation. [9][10][11] Kuecherer et al, 10 in 42 mechanically ventilated patients undergoing cardiovascular surgery, showed that Doppler TEE indices of pulmonic vein flow correlated with PCWP. Similarly, Hofmann et al, 11 in 32 mechanically ventilated patients undergoing cardiac surgery, demonstrated a significant correlation between mean left atrial pressure and pulmonary venous peak systolic to peak diastolic velocity ratio.…”

Alternative parameters for echocardiographic assessment of fetal diastolic function

“…Studies of diastolic function in adults using M-mode and Doppler echocardiography have shown the usefulness of unidimensional assessment of left atrial dynamics (6), atrioventricular (7)(8)(9) and pulmonary vein flow analysis (10)(11)(12)(13)(14) and, more recently, of tissue Doppler of atrioventricular rings and ventricular septum (15).…”