Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure with and without mitral regurgitation

Massimo Pozzoli, Soccorso Capomolla, Gianni Pinna, Franco Cobelli, Luigi Tavazzi

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Abstract

Objectives. This study was performed to assess whether the combination of multiple echocardiographic and Doppler variables can provide a reliable estimation of pulmonary artery wedge pressure in patients with chronic heart failure. Backgroud. In patients with chronic heart failure a high pulmonary artery wedge pressure is associated with poor prognosis, more severe symptoms and low exercise tolerance. Several Doppler echocardiographic indexes have been shown to be related to pulmonary artery wedge pressure, but the dispersion of data has generally not allowed a quantitative assessment of this important variable. Methods. Simultaneous Doppler echocardiographic examinations and right heart catheterizations were performed in 231 patients with chronic heart failure due to dilated cardiomyopathy. Mitral and pulmonary venous flow velocity variables, left atrial volumes, mitral resurgitation jet area and left ventricular ejection fraction were correlated with pulmonary artery wedge pressure by both single and multilinear regression analysis. The reliability of the obtained multilinear equations was then tested in a separate group of 60 patients. Results. By univariate analysis, the deceleration rate of early diastolic mitral flow and the systolic fraction of pulmonary venous how showed the strongest correlations (r = 0.78 and = -0.76; respectively). Stepwise regression analysis led to two multilinear equations for predicting pulmonary artery wedge pressure in the whole population: the first included only two dimensional echocardiographic and mitral flow velocity variables (r = 0.84) and the second also included pulmonary venous flow variables (r = 0.87). The highest correlation was obtained (r = 0.89) by a third equation in the 73 patients without significant mitral regurgita tion. Correlation coefficients between estimated and measured pulmonary artery wedge pressure were 0.91 (SEE = 2.7 mm Hg) and 0.97 (SEE 1.8 mm Hg) when the first and the second equation, respectively, were applied to the testing group. Conclusions. These results indicate that, in patients with chronic heart failure due to dilated cardiomyopathy, pulmonary artery wedge pressure can be reliably estimated even when mitral regurgitation is present by combining Doppler echocardiographic variables of mitral and pulmonary venous flow.

Original languageEnglish
Pages (from-to)883-893
Number of pages11
JournalJournal of the American College of Cardiology
Volume27
Issue number4
DOIs
Publication statusPublished - Mar 15 1996

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ASJC Scopus subject areas

  • Nursing(all)

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