The deceleration time of pulmonary venous diastolic flow is more accurate than the pulmonary artery occlusion pressure in predicting left atrial pressure

Objectives This study compared a prediction of mean left atrial pressure (P-LA) ascertained by Doppler echocardiography of pulmonary venous flow (PVF), with predicted P-LA using the pulmonary artery occlusion pressure (P-PAO). Background In select patient groups, PVF variables correlate with P-PAO, an indirect measure of P-LA. Methods In 93 patients undergoing cardiac surgery, we recorded with transesophageal echocardiography mitral valve early (E) and late (A) wave velocities, deceleration time (DT) of E (DTE), and pulmonary vein systolic (S) and diastolic (D) wave velocities, DT of D (DTD) and systolic fraction. The P-PAO was measured using a pulmonary artery catheter zeroed to midaxillary level. A further catheter was held at midatrial level to zero a transducer and was then inserted into the left atrium. A prediction rule for P-LA from DTD was developed in 50 patients and applied prospectively to estimate P-LA in 43 patients. Results A close correlation (r = -0.92) was found between P-LA and DTD. Systolic fraction (r = -0.63), DTE (r = -0.61), D wave (r = 0.57), E wave (r = 0.52), and E/A ratio (r = 0.13) correlated less closely with P-LA. The mean difference between predicted and measured P-LA was 0.58 mm Hg for DTD method and 1.72 mm Hg for P-PAO, with limits of agreement (mean +/- 2 SE) of -2.94 to 4.10 mm Hg and -2.48 to 5.92 mm Hg, respectively. A DTD of <175 ms had 100% sensitivity and 94% specificity for a P-LA of >17 mm Hg. Conclusions Deceleration time of pulmonary vein diastolic wave is more accurate than P-PAO in estimating left atrial pressure in cardiac surgical patients. (J Am Cell Cardiol 2001;37:2025-30) (C) 2001 by the American College of Cardiology.