Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit

Objective., To determine whether Doppler transmitral and pulmonary venous flow pattern is related to left ventricular filling pressures in critically ill patients. Design., Prospective clinical investigation. Setting. Medical intensive care unit of a university hospital. Patients. Fifty-four mechanically ventilated patients (age, 63 +/- 16 yrs) were investigated via transthoracic echocardiography and Doppler. Main diagnoses were pneumonia (31%), acute exacerbation of chronic obstructive pulmonary disease (24%), congestive heart failure (11%), and poisoning (11%). Interventions: Doppler examinations were performed simultaneously with measurements of pulmonary artery occlusion pressure via a right heart catheter. Measurements and Main Results., Pulmonary artery occlusion pressure correlated with transmitral peak E-wave velocity (r = .46) and E/A ratio (r = .55). Pulmonary artery occlusion pressure inversely correlated with deceleration time of the transmitral E-wave (r = -.52), pulmonary venous peak S-wave velocity (r = -.37), and systolic fraction of the pulmonary forward flow (r = -.56). An E/A ratio >2 predicted a pulmonary artery occlusion pressure >18 mm Hg with a positive predictive value of 100%. A duration of pulmonary venous A-wave reversal flow exceeding the duration of the transmitral A-wave forward flow predicted a pulmonary artery occlusion pressure >15 mm Hg with a positive predictive value of 83%. A systolic fraction of the pulmonary venous forward flow <0.4 predicted a pulmonary artery occlusion pressure >12 mm Hg with a positive predictive value of 100%. Conclusion. Transmitral and pulmonary venous flow patterns measured by transthoracic Doppler echocardiography can be used to estimate the left ventricular filling pressure in critically ill patients.