DOPPLER-DERIVED MITRAL DECELERATION TIME OF EARLY FILLING AS A STRONG PREDICTOR OF PULMONARY CAPILLARY WEDGE PRESSURE IN POSTINFARCTION PATIENTS WITH LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION

Objectives. The aim of this study was to investigate the correlations between Doppler-derived transmitral flow velocity variables and pulmonary capillary wedge pressure in patients with severe left ventricular systolic dysfunction. Background. Abnormal relaxation and increased chamber stiffness have opposing effects on the left ventricular filling pat tern. When both abnormalities are present at the same time, as often occurs in patients with systolic dysfunction, the ability of Doppler recording to assess diastolic function and predict left ventricular filling pressure may be significantly compromised. Method. Pulmonary capillary wedge pressure and Doppler transmitral Bow velocity profile were simultaneously recorded in 140 postinfarction patients with ejection fraction less than or equal to 35%. Results. Correlation between the ratio of mitral peak Bow velocity in early diastole to peak Bow velocity in late diastole (E/A ratio) and pulmonary capillary wedge pressure was weak (r = 0.65). Although the specificity of E/A greater than or equal to 2 in predicting greater than or equal to 20 mm Hg in pulmonary capillary wedge pressure was high (99%), its sensitivity was low (43%). Conversely, a very close negative correlation was found between mitral deceleration time of early filling and pulmonary capillary wedge pressure (r = -0.90). Sensitivity and specificity of less than or equal to 120 ms in deceleration time in predicting greater than or equal to 20 mm Hg in pulmonary capillary wedge pressure were 100% and 99%, respectively. Conclusions. Doppler derived mitral deceleration time of early filling provides a simple and accurate means of estimating pulmonary capillary wedge pressure that is particularly useful in patients with a normal or normalized mitral flow velocity pattern.