ASSESSMENT OF LEFT ATRIAL PRESSURE AND VOLUME CHANGES DURING ATRIAL SYSTOLE WITH TRANSESOPHAGEAL PULSED DOPPLER-ECHOCARDIOGRAPHY OF TRANSMITRAL AND PULMONARY VENOUS FLOW VELOCITIES

To determine whether transmitral and pulmonary venous flow velocity pa tterns can be used to evaluate left atrial pressure and volume changes during atrial systole, we performed transesophageal pulsed Doppler ec hocardiography and right heart catheterization in 85 patients (20 with hypertrophic cardiomyopathy, 20 with dilated cardiomyopathy, 30 with prior myocardial infarction, and 15 with mitral regurgitation), and 35 normal subjects. Pulsed Doppler variables from transmitral and pulmon ary venous flow velocities during atrial systole were compared with me an pulmonary capillary wedge pressure (mean PCWP), pressure rise durin g atrial systole (PCWP-A), and left atrial volume change during atrial systole (Delta LAV). The mean PCWP correlated sig significantly with the peak atrial systolic transmitral flow (r = -0.38, p < 0.05) and pu lmonary venous flow (r = 0.40, p < 0.05) velocities in all patients. T he PCWP-A correlated significantly with the peak atrial systolic trans mitral flow (r = -0.39, p < 0.05) and pulmonary venous flow (r = 0.68, P < 0.0001) velocities in all patients. There was a particularly clos e correlation between the PCWP-A and the peak atrial systolic pulmonar y venous flow velocities. The sum of the time-velocity integral of the atrial systolic transmitral and pulmonary venous flow velocities (TAI ) correlated closely with the Delta LAV (r = 0.70, P < 0.0001) in all patients. Thus, the peak atrial systolic pulmonary venous flow velocit y correlated well with left atrial pressure changes during atrial syst ole. Furthermore, the sum of the time-velocity integral of the atrial systolic transmitral and pulmonary venous flow velocities correlated w ell with left atrial volume changes during atrial systole. Therefore, transesophageal echocardiographic measurements of atrial systolic tran smitral and pulmonary venous flow velocities are reasonable indicators of left atrial pressure and volume changes during atrial systole.